Provider Demographics
NPI:1831160027
Name:GUMIDYALA, LALITHA V (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:V
Last Name:GUMIDYALA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 MILAN STREET
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045
Mailing Address - Country:US
Mailing Address - Phone:732-512-7895
Mailing Address - Fax:484-884-7053
Practice Address - Street 1:1770 BATHGATE RD, SUITE #200
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:484-884-2249
Practice Address - Fax:484-884-7053
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475971207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01007800901OtherAMERICHOICE
NJ0088668Medicaid
NJ305282OtherAMERIGROUP
NJ01007800901OtherAMERICHOICE
NJ0890694E6MMedicare PIN
NJ083069UXLMedicare PIN
NJ305282OtherAMERIGROUP
NJ083069P7GMedicare PIN
NJ083069TM8Medicare PIN
NJ083069Medicare ID - Type Unspecified