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NPI Code Detail

MEDICARE: DR. SMITHA REDDY PASULA M.D.

MEDICARE: DR. SMITHA REDDY PASULA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician201101319NC

General Provider Information

NPI Number : 1063707354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SMITHA REDDY PASULA M.D.
Provider Business Mailing Address
First Line : 104 PROSPECT AVE
Second Line :
City : BAYONNE
State : NJ
Zip : 07002-4542
Country : US
Telephone Number : 201-658-2864
Fax Number :
Provider Business Practice Location Address
First Line : 930 W WILSON AVE
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-8811
Country : US
Telephone Number : 704-663-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2011
Last Update Date : 04/03/2012

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