Healthcare Provider Details

I. General information

NPI: 1750572640
Provider Name (Legal Business Name): PAVANI GUNDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E LAUREL RD
STRATFORD NJ
08084-1327
US

IV. Provider business mailing address

151 FRIES MILL RD STE 400
TURNERSVILLE NJ
08012-2016
US

V. Phone/Fax

Practice location:
  • Phone: 856-513-4124
  • Fax: 856-302-5932
Mailing address:
  • Phone: 856-513-4124
  • Fax: 856-302-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09394300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: