Provider Demographics
NPI:1548426935
Name:UNTAWALE, VASUNDHARA G (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUNDHARA
Middle Name:G
Last Name:UNTAWALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VASUNDHARA
Other - Middle Name:G
Other - Last Name:UNTAWALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:281 FARMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6555
Mailing Address - Country:US
Mailing Address - Phone:973-628-8361
Mailing Address - Fax:
Practice Address - Street 1:1 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1011
Practice Address - Country:US
Practice Address - Phone:201-393-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA038639207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology