Provider Demographics
NPI:1417032855
Name:YELCHUR, ANURADHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:
Last Name:YELCHUR
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 1:8 QUEENS PASS
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1760
Mailing Address - Country:US
Mailing Address - Phone:732-308-4396
Mailing Address - Fax:
Practice Address - Street 1:71 MAIN STREET
Practice Address - Street 2:INSTACARE MEDICAL CENTER
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882
Practice Address - Country:US
Practice Address - Phone:732-254-8400
Practice Address - Fax:732-254-8484
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7851502Medicaid
NJ7851502Medicaid
NJ024020Medicare ID - Type Unspecified