Provider Demographics
NPI:1598782930
Name:THOPCHERLA, MANJULA (MD)
Entity Type:Individual
Prefix:
First Name:MANJULA
Middle Name:
Last Name:THOPCHERLA
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 1:18106 LAMBERT WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4863
Mailing Address - Country:US
Mailing Address - Phone:732-252-5178
Mailing Address - Fax:
Practice Address - Street 1:1255 HIGHWAY 70
Practice Address - Street 2:SUITE # 24-S
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5900
Practice Address - Country:US
Practice Address - Phone:732-730-0020
Practice Address - Fax:732-730-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07869400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH53352Medicare UPIN