Provider Demographics
NPI:1851591622
Name:VEDULA, RAMYA SMITA (DO)
Entity Type:Individual
Prefix:DR
First Name:RAMYA
Middle Name:SMITA
Last Name:VEDULA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RAMYA
Other - Middle Name:SMITA
Other - Last Name:KOTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9481
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ026MB08680700207R00000X
NH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine