Healthcare Provider Details

I. General information

NPI: 1912987587
Provider Name (Legal Business Name): PRAMEELA M PALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 1800
STRATFORD NJ
08084-1338
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6842
  • Fax: 856-566-6419
Mailing address:
  • Phone: 856-566-6842
  • Fax: 856-566-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06075400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA06075400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: