Provider Demographics
NPI:1073544284
Name:KUCHIPUDI, SOLOMON S (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:S
Last Name:KUCHIPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1975
Mailing Address - Country:US
Mailing Address - Phone:732-220-8811
Mailing Address - Fax:732-220-1300
Practice Address - Street 1:636 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1975
Practice Address - Country:US
Practice Address - Phone:732-220-8811
Practice Address - Fax:732-220-1300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA74312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH71100Medicare UPIN
NJ063040Medicare ID - Type Unspecified
NJ063040Medicare PIN