MEDICARE: DR. PADMAJA KODALI 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	207RN0300X	Nephrology Physician	25MA06878300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790747764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PADMAJA KODALI MD

Provider Business Mailing Address
First Line	:	2040 MILLBURN AVE
Second Line	:	SUITE 403
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3726
Country	:	US
Telephone Number	:	973-763-1100
Fax Number	:	973-763-1122

Provider Business Practice Location Address
First Line	:	2040 MILLBURN AVE
Second Line	:	SUITE 403
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3726
Country	:	US
Telephone Number	:	973-763-1100
Fax Number	:	973-763-1122

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	12/17/2012

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