Provider Demographics
NPI:1902194376
Name:BOOPATHI, AMUDHA (MD,)
Entity Type:Individual
Prefix:DR
First Name:AMUDHA
Middle Name:
Last Name:BOOPATHI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:AMUDHA
Other - Middle Name:
Other - Last Name:PALANIAPPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:30265 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3593
Practice Address - Country:US
Practice Address - Phone:302-629-5050
Practice Address - Fax:302-629-5053
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10011009208D00000X
DEC1-0011009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103448773Medicaid