Provider Demographics
NPI:1780630764
Name:VELDANDA, ASHOKVARDHAN R (MD)
Entity Type:Individual
Prefix:
First Name:ASHOKVARDHAN
Middle Name:R
Last Name:VELDANDA
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 1:1364 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2485
Mailing Address - Country:US
Mailing Address - Phone:609-597-3416
Mailing Address - Fax:609-597-9608
Practice Address - Street 1:1364 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2485
Practice Address - Country:US
Practice Address - Phone:609-597-3416
Practice Address - Fax:609-597-9608
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74234Medicare UPIN
011536-AW2Medicare ID - Type Unspecified