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Individual

NITYA BANDLA MAMBALAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D,

Contact information

Practice address
1417 8TH AVE, BETHLEHEM, PA 18018-2256
(484) 526-5210
(484) 526-5237
Mailing address
1417 8TH AVE, BETHLEHEM, PA 18018-2256
(484) 526-5210
(484) 526-5237

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD458239
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2013021634
MISSOURI TEMPORARY LICENSE
MO
Enumeration date
06/28/2013
Last updated
10/28/2025
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