Provider Demographics
NPI:1548574346
Name:PONNAMANENI, ABHILASHA RAO (MD)
Entity Type:Individual
Prefix:
First Name:ABHILASHA
Middle Name:RAO
Last Name:PONNAMANENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:811 SUNSET RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3645
Mailing Address - Country:US
Mailing Address - Phone:609-387-9242
Mailing Address - Fax:609-387-9408
Practice Address - Street 1:639 STOKES RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3003
Practice Address - Country:US
Practice Address - Phone:609-654-7556
Practice Address - Fax:609-714-9228
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2012-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08964100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine