Individual
DR. SUMA BALA GHANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
183 ROUTE 206, FLANDERS, NJ 07836-9050
(973) 347-3277
(973) 347-3141
Mailing address
402 LIPPINCOTT DR, MARLTON, NJ 08053-4112
(856) 782-3300
(856) 504-8029
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
25MA07257600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8825106
—
NJ
Enumeration date
06/12/2006
Last updated
03/22/2010
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