MEDICARE: VADAKARA INTERNAL MEDICINE ASSOCIATES PA

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	58765	OTHER	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1110350	OTHER	HORIZON NJ HEALTH
4	2144772001	OTHER	KEYSTONE
5	2946A	OTHER	UNIVERSITY HEALTH PLAN

General Provider Information

NPI Number	:	1952434052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VADAKARA INTERNAL MEDICINE ASSOCIATES PA

Provider Business Mailing Address
First Line	:	2117 KLOCKNER RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08690-3417
Country	:	US
Telephone Number	:	609-584-1001
Fax Number	:	609-584-0404

Provider Business Practice Location Address
First Line	:	2117 KLOCKNER RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08690-3417
Country	:	US
Telephone Number	:	609-584-1001
Fax Number	:	609-584-0404

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LUKOSE VADAKARA
Credential	:	MD
Telephone Number	:	609-584-1001

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/06/2010

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