Provider Demographics
NPI:1215411269
Name:SUMMIT PRIMARY CARE AND INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:SUMMIT PRIMARY CARE AND INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARUNPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VADIVELU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-589-3271
Mailing Address - Street 1:118 LYNN AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3709
Mailing Address - Country:US
Mailing Address - Phone:732-589-3271
Mailing Address - Fax:
Practice Address - Street 1:118 LYNN AVE STE 502
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3709
Practice Address - Country:US
Practice Address - Phone:469-909-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-15
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty