Provider Demographics
NPI:1346381183
Name:TUMMALAPENTA, NIRMALA (MD)
Entity Type:Individual
Prefix:
First Name:NIRMALA
Middle Name:
Last Name:TUMMALAPENTA
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 1:2550 WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3930
Mailing Address - Country:US
Mailing Address - Phone:732-406-5985
Mailing Address - Fax:718-799-5356
Practice Address - Street 1:2550 WEBB AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3930
Practice Address - Country:US
Practice Address - Phone:732-406-5985
Practice Address - Fax:718-799-5356
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216016-1207R00000X
NY216016207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH56492Medicare UPIN