Provider Demographics
NPI:1194189209
Name:NIMMA, ANITHA (MD)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:NIMMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3120 PRINCETON PIKE
Mailing Address - Street 2:FL 2
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2325
Mailing Address - Country:US
Mailing Address - Phone:609-896-1701
Mailing Address - Fax:609-896-3735
Practice Address - Street 1:3120 PRINCETON PIKE FL 2
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2325
Practice Address - Country:US
Practice Address - Phone:609-896-1701
Practice Address - Fax:609-896-3735
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA107900002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty