Provider Demographics
NPI:1659460509
Name:BUDDALA, SANGEETA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANGEETA
Middle Name:
Last Name:BUDDALA
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 1:7 SHOREHAM CT
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5101
Mailing Address - Country:US
Mailing Address - Phone:609-371-7997
Mailing Address - Fax:
Practice Address - Street 1:RT. 72 EAST
Practice Address - Street 2:NEW LISBON DEVELOPMENTAL CENTER
Practice Address - City:NEW LISBON
Practice Address - State:NJ
Practice Address - Zip Code:08064
Practice Address - Country:US
Practice Address - Phone:609-726-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO7340500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH70909Medicare UPIN