Provider Demographics
NPI:1235289307
Name:DANTULURI, HEMAMALINI (MD)
Entity Type:Individual
Prefix:
First Name:HEMAMALINI
Middle Name:
Last Name:DANTULURI
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 1:21 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1632
Mailing Address - Country:US
Mailing Address - Phone:908-668-2265
Mailing Address - Fax:
Practice Address - Street 1:MRMC PARK AVE AND RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07061
Practice Address - Country:US
Practice Address - Phone:908-668-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07992500208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096638UVFMedicare ID - Type Unspecified
NJI47001Medicare UPIN