Healthcare Provider Details

I. General information

NPI: 1952428682
Provider Name (Legal Business Name): AMUDHA PALANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 WARWICK BLVD SUITE A
NEWPORT NEWS VA
23606-2501
US

IV. Provider business mailing address

860 OMNI BLVD SUITE #303
NEWPORT NEWS VA
23602
US

V. Phone/Fax

Practice location:
  • Phone: 757-595-9880
  • Fax: 757-595-0362
Mailing address:
  • Phone: 757-232-8777
  • Fax: 757-232-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101240408
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101240408
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: