Individual
ABHILASHA RAO PONNAMANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
639 STOKES RD, SUITE 102, MEDFORD, NJ 08055-3003
(609) 654-7556
(609) 714-9228
Mailing address
811 SUNSET RD, SUITE 101, BURLINGTON, NJ 08016-3645
(609) 387-9242
(609) 387-9408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA08964100
NJ
Other
Enumeration date
08/04/2010
Last updated
08/14/2012
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