Provider Demographics
NPI:1790993988
Name:VADAPARAMPIL, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:VADAPARAMPIL
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 1:4453 CASTOR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3846
Mailing Address - Country:US
Mailing Address - Phone:215-744-2266
Mailing Address - Fax:215-743-9247
Practice Address - Street 1:4453 CASTOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3846
Practice Address - Country:US
Practice Address - Phone:212-523-5918
Practice Address - Fax:215-743-9247
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434573207R00000X
PAMT187155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021914320001Medicaid
NJ0168564Medicaid
NJ0168564Medicaid