Provider Demographics
NPI:1710967039
Name:BHAMIDIPATI, APARNA (MD)
Entity Type:Individual
Prefix:
First Name:APARNA
Middle Name:
Last Name:BHAMIDIPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:APARNA
Other - Middle Name:
Other - Last Name:BHAMIDIPATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:435 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1576
Mailing Address - Country:US
Mailing Address - Phone:908-659-9200
Mailing Address - Fax:
Practice Address - Street 1:435 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1576
Practice Address - Country:US
Practice Address - Phone:908-659-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079715002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine