Provider Demographics
NPI:1205810926
Name:MARULENDRA, SHIVAPRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVAPRASAD
Middle Name:
Last Name:MARULENDRA
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 1:27 TARA WAY
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2100
Mailing Address - Country:US
Mailing Address - Phone:609-477-3003
Mailing Address - Fax:
Practice Address - Street 1:27 TARA WAY
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2100
Practice Address - Country:US
Practice Address - Phone:609-477-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06405900174400000X
IL036141750207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH28B141OtherEMPIRE HEALTH CARE
NH3977218008OtherCIGNA
NJ0000653760001OtherONE HEALTH PLAN
IL214881OtherMEDICARE GROUP PTAN
NJ5711065OtherGHI
NJ63162OtherLOCAL 825 PPO
NJ7050607Medicaid
NH744595OtherFIRST HEALTH
NJ2K7529OtherHEALTHNET
NJ4651687OtherAETNAPPO
NJ143398OtherCHN
NJ16536OtherAMERICAID
NH0985179000OtherAMERIHEALTH HMO
NJ222233588OtherHORIZON BC/BS
NJ1091534OtherHORIZON NJ HEALTH
NJ2172624OtherAETNA HMO
NJ869482OtherAMERIHEALTH PPO
NJ010002878-00OtherAMERICHOICE
NH222233588OtherMULTIPLAN
NH222233588OtherMULTIPLAN
NJMA869482Medicare PIN