Provider Demographics
NPI:1841248036
Name:GOLLAPUDI, DEVI P (MD)
Entity type:Individual
Prefix:DR
First Name:DEVI
Middle Name:P
Last Name:GOLLAPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2642
Mailing Address - Country:US
Mailing Address - Phone:908-852-8750
Mailing Address - Fax:908-852-8820
Practice Address - Street 1:47 ROUTE 46
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2642
Practice Address - Country:US
Practice Address - Phone:908-852-8750
Practice Address - Fax:908-852-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ896990OtherMEDICARE
NJ7914300Medicaid
NJG40131Medicare UPIN
NJ7914300Medicaid