Provider Demographics
NPI:1083727382
Name:TUMMALA, SUMALATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMALATHA
Middle Name:
Last Name:TUMMALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6007
Mailing Address - Country:US
Mailing Address - Phone:609-918-0333
Mailing Address - Fax:609-918-0336
Practice Address - Street 1:1757 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-6007
Practice Address - Country:US
Practice Address - Phone:609-918-0333
Practice Address - Fax:609-918-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8624704Medicaid
NJ028688Medicare ID - Type Unspecified
NJ8624704Medicaid