Provider Demographics
NPI:1710958624
Name:MANDALAPU, PADMA (MS,MD,FAAP)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:
Last Name:MANDALAPU
Suffix:
Gender:F
Credentials:MS,MD,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1440
Mailing Address - Country:US
Mailing Address - Phone:609-641-0200
Mailing Address - Fax:
Practice Address - Street 1:2322 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1440
Practice Address - Country:US
Practice Address - Phone:609-641-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8331707Medicaid
NJDO7212500OtherCDA NUMBER
NJBM5461215OtherDEA REGISTRATION
NJ8331707Medicaid