Provider Demographics
NPI:1083695373
Name:MARELLA, VENKATA KOTESWARARAO (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:KOTESWARARAO
Last Name:MARELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KOTESWARARAO
Other - Middle Name:VENKATA
Other - Last Name:MARELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1033 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:973-473-5700
Mailing Address - Fax:973-473-3367
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-473-5700
Practice Address - Fax:973-473-3367
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08210500208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34104Medicare UPIN
I34104Medicare UPIN
RA7351Medicare ID - Type Unspecified