Provider Demographics
NPI:1326287624
Name:ANNE, MADHURIMA (MD)
Entity Type:Individual
Prefix:MS
First Name:MADHURIMA
Middle Name:
Last Name:ANNE
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 1:19 DAVIS AVE
Mailing Address - Street 2:2ND FLR-HEM/ONC
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-528-0760
Mailing Address - Fax:732-528-0764
Practice Address - Street 1:1707 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-528-0760
Practice Address - Fax:732-528-0764
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09569800207RH0003X
NY250916207R00000X
OH309927207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088724Medicaid
OHH234000Medicare PIN