Provider Demographics
NPI:1184718306
Name:VINNAKOTA, RADHA (MD)
Entity type:Individual
Prefix:DR
First Name:RADHA
Middle Name:
Last Name:VINNAKOTA
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 1:6 RAVINN LN
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5572
Mailing Address - Country:US
Mailing Address - Phone:908-753-2662
Mailing Address - Fax:908-753-2633
Practice Address - Street 1:2013 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5401
Practice Address - Country:US
Practice Address - Phone:908-753-2662
Practice Address - Fax:908-753-2633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJMA30649207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1347101Medicaid
NJ192304Medicare PIN
NJD06292Medicare UPIN