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General NPI Number Information
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NPI Number | 1275620650
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Entity Type | Individual
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Provider Name | SMITHA AYODHYARAM GUBBI MD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 215 UNION AVE BRIDGEWATER INTERNAL MEDICINE SUITE E
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City | BRIDGEWATER
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State | NJ
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Zip | 08807
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Country | US
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Telephone | 908-685-1818
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Fax | 908-685-8225
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Provider Business Mailing Address
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Address Line | PO BOX 416457
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City | BOSTON
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State | MA
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Zip | 02241-6457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA07648800
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License Number State | NJ
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