Provider Demographics
NPI:1881799450
Name:PUTCHA, VASUNDHARA (MD)
Entity type:Individual
Prefix:
First Name:VASUNDHARA
Middle Name:
Last Name:PUTCHA
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 1:8 VANDERBILT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-535-0514
Mailing Address - Fax:
Practice Address - Street 1:147 COLUMBIA TPKE
Practice Address - Street 2:SUITE304
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2113
Practice Address - Country:US
Practice Address - Phone:973-966-9090
Practice Address - Fax:973-966-9777
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA560752084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ108090Medicare UPIN