MEDICARE: DR. LAKSHMI PRIYA NULU MD, FAAP

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	208000000X	Pediatrics Physician	MD449059	PA

General Provider Information

NPI Number	:	1902245954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAKSHMI PRIYA NULU MD, FAAP

Provider Business Mailing Address
First Line	:	751 E 16TH ST
Second Line	:	SUITE 400
City	:	BERWICK
State	:	PA
Zip	:	18603-2321
Country	:	US
Telephone Number	:	718-916-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 E 98TH ST
Second Line	:	APT 7B
City	:	BROOKLYN
State	:	NY
Zip	:	11236-1356
Country	:	US
Telephone Number	:	718-916-1200
Fax Number	:

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	04/01/2014

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