Provider Demographics
NPI:1205949468
Name:KURRA, PADMAVATHY (MD)
Entity type:Individual
Prefix:DR
First Name:PADMAVATHY
Middle Name:
Last Name:KURRA
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 1:15-01 BROADWAY
Mailing Address - Street 2:SUITE 10-B
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6003
Mailing Address - Country:US
Mailing Address - Phone:201-794-7733
Mailing Address - Fax:201-794-6039
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:SUITE 10-B
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-794-7733
Practice Address - Fax:201-794-6039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA051202002084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129208Medicaid
NJ541309 DMSMedicare ID - Type Unspecified
NJ0129208Medicaid