Provider Demographics
NPI:1114606555
Name:DEVULAPALLI MEDICAL PLLC
Entity Type:Organization
Organization Name:DEVULAPALLI MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVULAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-545-7729
Mailing Address - Street 1:500 MAMARONECK AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1600
Mailing Address - Country:US
Mailing Address - Phone:914-771-7373
Mailing Address - Fax:914-337-6757
Practice Address - Street 1:500 MAMARONECK AVE STE 211
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1600
Practice Address - Country:US
Practice Address - Phone:914-771-7373
Practice Address - Fax:914-337-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003105099OtherINDIVIDUAL NPI