Provider Demographics
NPI:1619144060
Name:MAMILLAPALLI, PADMAJA D (MD)
Entity Type:Individual
Prefix:
First Name:PADMAJA
Middle Name:D
Last Name:MAMILLAPALLI
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Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:130 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE H-321
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-4097
Mailing Address - Fax:484-337-4082
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:SUITE H-321
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:484-337-4097
Practice Address - Fax:610-526-4082
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2018-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD434782207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine