Individual
DR. PRASAD MEDEPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15-01 BROADWAY (SUITE), SUITE 38, FAIRLAWN, NJ 07410
(201) 791-9241
Mailing address
15-01 BROADWAY (SUITE), FAIRLAWN, NJ 07410
(201) 791-9241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30507
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2984300
—
NJ
Enumeration date
06/15/2006
Last updated
07/08/2007
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