Provider Demographics
NPI:1598945412
Name:VUDARLA, NEELIMA (MD)
Entity Type:Individual
Prefix:
First Name:NEELIMA
Middle Name:
Last Name:VUDARLA
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 1:1450 PARKSIDE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2948
Mailing Address - Country:US
Mailing Address - Phone:609-789-0777
Mailing Address - Fax:609-789-0776
Practice Address - Street 1:1450 PARKSIDE AVE STE 4
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2948
Practice Address - Country:US
Practice Address - Phone:609-789-0777
Practice Address - Fax:609-789-0776
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08594900208M00000X, 207R00000X
DEC1-0008538208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30060273OtherKEYSTONE MERCY
PAP00765931OtherRR MEDICARE
PA30060273OtherKEYSTONE MERCY-LOWER BUCKS GROUP
PA102290468 0001Medicaid
PA3546646000OtherKEYSTONE HEALTH PLAN EAST
PA147328ZDKTMedicare PIN
PA30060273OtherKEYSTONE MERCY-LOWER BUCKS GROUP