Provider Demographics
NPI:1912912585
Name:BOINAPALLY, NIVEDITA (MD)
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:
Last Name:BOINAPALLY
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 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-217-4300
Practice Address - Fax:717-217-4399
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071648L207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039277OtherJOHNS HOPKINS
PA02113702OtherCAPITAL BC-WMG YFM
MD607889OtherCAREFIRST MD BCBS
PA202294OtherUNISON-WMG READYCARE
PA50066448OtherCAPITAL BC-WMG READYCARE
PA777707OtherHIGHMARK BLUE SHIELD
PA7781478OtherAETNA
PA2161250OtherMAMSI-WMG READYCARE
PA65738OtherGEISINGER
PA50063724OtherCAPITAL BC-WMG CFA
PAP002815OtherGATEWAY-WMG
PA001811880Medicaid
PA20064069OtherAMERIHEALTH MERCY - WMG
PA1142408OtherAMERIHEALTH MERCY-WMG
PA193126OtherUNISON-WMG CFA
PA110500OtherUNISON-WMG YFM
PA283462OtherMAMSI-WMG
PA20064069OtherAMERIHEALTH MERCY - WMG
PA283462OtherMAMSI-WMG
PA7781478OtherAETNA