Provider Demographics
NPI:1275543027
Name:ISUKAPALLI, PADMAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAJA
Middle Name:
Last Name:ISUKAPALLI
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 1:1024 PARK AVE
Mailing Address - Street 2:SUITE 6 A
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3026
Mailing Address - Country:US
Mailing Address - Phone:908-222-8400
Mailing Address - Fax:908-222-8402
Practice Address - Street 1:1024 PARK AVE
Practice Address - Street 2:SUITE 6 A
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3026
Practice Address - Country:US
Practice Address - Phone:908-222-8400
Practice Address - Fax:908-222-8402
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07690000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07690000OtherMEDICAL LICENSE
NJD08482300OtherCDS
NJD08482300OtherCDS