Provider Demographics
NPI:1780037507
Name:KODURU, BEULAH JYOTHY (MD)
Entity Type:Individual
Prefix:
First Name:BEULAH JYOTHY
Middle Name:
Last Name:KODURU
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 1:6301 ALAMEDA BLVD NE UNIT 2007
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2587
Mailing Address - Country:US
Mailing Address - Phone:312-909-7318
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO HOSPITAL MSC 10 5550
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-5640
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.068685207R00000X
NMMD2020-0643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine