Provider Demographics
NPI:1609856913
Name:BOLLAMPALLY, INDIRA (MD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:BOLLAMPALLY
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 1:1540 HWY 138
Mailing Address - Street 2:SUITE208
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3763
Mailing Address - Country:US
Mailing Address - Phone:732-681-9045
Mailing Address - Fax:732-894-3923
Practice Address - Street 1:1540 HWY 138
Practice Address - Street 2:SUITE208
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3763
Practice Address - Country:US
Practice Address - Phone:732-681-9045
Practice Address - Fax:732-681-9494
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39866207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE85637Medicare UPIN