Provider Demographics
NPI:1457343949
Name:GURIJALA, LALITHA (MD037420-L)
Entity Type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:GURIJALA
Suffix:
Gender:F
Credentials:MD037420-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 W. BALTIMORE PIKE
Mailing Address - Street 2:OP PAVILION, SUITE 3311
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-892-9982
Mailing Address - Fax:610-565-1425
Practice Address - Street 1:1098 W. BALTIMORE PIKE
Practice Address - Street 2:OP PAVILION, SUITE 3311
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-892-9982
Practice Address - Fax:610-565-1425
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037420-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE95631Medicare UPIN
025476Medicare ID - Type Unspecified