Provider Demographics
NPI:1275730053
Name:MUPPALA, SUJATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:
Last Name:MUPPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUJATHA
Other - Middle Name:
Other - Last Name:MUPPALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1700 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07063-1000
Mailing Address - Country:US
Mailing Address - Phone:908-753-6401
Mailing Address - Fax:908-226-6743
Practice Address - Street 1:1 ETHEL RD STE 106A
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-902-6006
Practice Address - Fax:732-902-6005
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08642700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine