Provider Demographics
NPI:1487840039
Name:KANIKICHARLA, UMA (MD)
Entity Type:Individual
Prefix:DR
First Name:UMA
Middle Name:
Last Name:KANIKICHARLA
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 1:41 WILSON AVENUE
Mailing Address - Street 2:# 2D
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3612
Mailing Address - Country:US
Mailing Address - Phone:973-589-7337
Mailing Address - Fax:973-589-1905
Practice Address - Street 1:41 WILSON AVENUE
Practice Address - Street 2:# 2D
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3612
Practice Address - Country:US
Practice Address - Phone:973-589-7337
Practice Address - Fax:973-589-1905
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08291800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141151Medicaid
NJ25MA08291800OtherLICENSE