Provider Demographics
NPI:1972505311
Name:KODURI, BEAULA V (MD)
Entity Type:Individual
Prefix:DR
First Name:BEAULA
Middle Name:V
Last Name:KODURI
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:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-9177
Mailing Address - Country:US
Mailing Address - Phone:732-483-4501
Mailing Address - Fax:732-483-4502
Practice Address - Street 1:2110 OAK TREE ROAD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3626
Practice Address - Country:US
Practice Address - Phone:732-483-4501
Practice Address - Fax:732-483-4502
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08158600207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0140562Medicaid
NJ114949Medicare PIN
NJH58903Medicare UPIN