Individual
MRS. BHAVANI DURGA VIETLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2864 ROUTE 27, SUITE D, NORTH BRUNSWICK, NJ 08902-5010
(732) 297-4272
(732) 297-3785
Mailing address
1 WINDMILL CT, PLAINSBORO, NJ 08536-3146
(732) 297-4272
(732) 297-3785
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA06986200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006734
—
NJ
01
—
P01008431
RR MEDICARE
NJ
01
—
P01130911
RAILROAD MEDICARE
NJ
Enumeration date
06/04/2006
Last updated
02/21/2013
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