Provider Demographics
NPI:1639124506
Name:PALLIMULLA, MAHIPA HEWA (MD)
Entity Type:Individual
Prefix:
First Name:MAHIPA
Middle Name:HEWA
Last Name:PALLIMULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HAMBURG TPKE
Mailing Address - Street 2:STE 21
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-570-2727
Mailing Address - Fax:
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:SUITE 21
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-790-8090
Practice Address - Fax:973-790-3198
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07089000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000416905OtherAMERICHOICE OF NJ
NJ01000416908OtherAMERICHOICE OF NJ
NY987D31OtherEMPIRE BCBS
NJP2843436OtherOXFORD HEALTHCARE
NJ01000416900OtherAMERICHOICE OF NJ
NJ1790731271OtherGRP NPI COMPREHENSIVE WOMEN'S HEALTHCARE
NJ96127OtherAMERIGROUP MEDICAID HMO
NJ1169311OtherHORIZON NJ HEALTH
NJ1942421070OtherGRP NPI SURGAIDE 1, LLC
NJ8327602Medicaid
NJ0464125OtherCIGNA
NJ01000416907OtherAMERICHOICE OF NJ
NJ01000416910OtherAMERICHOICE OF NJ
NJ1356533624OtherGRP NPI SURGAIDE 2, LLC
NJ2001661000OtherAMERIHEALTH
NJ3725083OtherAETNA
NJ1169311OtherHORIZON NJ HEALTH
NJ8327602Medicaid