Healthcare Provider Details

I. General information

NPI: 1831160027
Provider Name (Legal Business Name): LALITHA V GUMIDYALA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 BATHGATE RD, SUITE #200
BETHLEHEM PA
18017
US

IV. Provider business mailing address

3195 MILAN STREET
EASTON PA
18045
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-2249
  • Fax: 484-884-7053
Mailing address:
  • Phone: 732-512-7895
  • Fax: 484-884-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD475971
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD475971
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: