MEDICARE: VANITHA YADALLA MD

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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	25MA07674100	NJ
2	207RH0005X	Hypertension Specialist Physician	25MA07674100	NJ
3	207R00000X	Internal Medicine Physician	25MA07674100	NJ

General Provider Information

NPI Number	:	1093702961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANITHA YADALLA MD

Provider Business Mailing Address
First Line	:	3350 RTE 138 STE 117
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9694
Country	:	US
Telephone Number	:	732-280-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 RTE 138 STE 117
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9694
Country	:	US
Telephone Number	:	732-280-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/17/2025

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Directions to “ VANITHA YADALLA MD” Practice Location

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