Healthcare Provider Details

I. General information

NPI: 1861845604
Provider Name (Legal Business Name): SAMEERA MOKKARALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 LOCUST ST
PHILADELPHIA PA
19107-6734
US

IV. Provider business mailing address

768 S 19TH ST
PHILADELPHIA PA
19146-1843
US

V. Phone/Fax

Practice location:
  • Phone: 556-021-5351
  • Fax:
Mailing address:
  • Phone: 650-793-4113
  • Fax: 267-536-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License NumberMD486254
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: