Provider Demographics
NPI:1558397083
Name:PADULA, VINCENT M (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:PADULA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 73 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9642
Mailing Address - Country:US
Mailing Address - Phone:856-797-5777
Mailing Address - Fax:856-797-5771
Practice Address - Street 1:525 ROUTE 73 S
Practice Address - Street 2:SUITE 103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9642
Practice Address - Country:US
Practice Address - Phone:856-797-5777
Practice Address - Fax:856-797-5771
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06738800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ022455Medicare ID - Type Unspecified
G44308Medicare UPIN