Provider Demographics
NPI:1912987587
Name:PALLI, PRAMEELA M (MD)
Entity Type:Individual
Prefix:
First Name:PRAMEELA
Middle Name:M
Last Name:PALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:UDP #1800
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-6843
Mailing Address - Fax:856-566-6419
Practice Address - Street 1:42 LAUREL RD E
Practice Address - Street 2:UDP #1800
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-6843
Practice Address - Fax:856-566-6419
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06075400207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6228500Medicaid
NJ198667CKPMedicare PIN
NJF86998Medicare UPIN