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General NPI Number Information
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NPI Number | 1356580054
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Entity Type | Individual
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Provider Name | SUCHARITHA KANKANALA MD
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Gender | Female
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 401 YOUNG AVE STE 245B
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3132
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Country | US
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Telephone | 856-727-0900
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Fax | 856-231-8428
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Provider Business Mailing Address
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Address Line | 4 CASSOTTA LN
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City | SUFFIELD
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State | CT
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Zip | 06078-1382
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Country | US
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Telephone | 413-464-9025
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Fax | 409-772-8709
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD453042
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25MA09643100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD453042
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License Number State | PA
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