Provider Demographics
NPI:1285695510
Name:VADIVELU, ARUNPRIYA (MD)
Entity type:Individual
Prefix:
First Name:ARUNPRIYA
Middle Name:
Last Name:VADIVELU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LYNN AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 LYNN AVE STE 502
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3709
Practice Address - Country:US
Practice Address - Phone:469-909-1931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101426795 0001Medicaid
PA2451154000OtherBC/BS OF PENNSYLVANIA
PAP00249959OtherRAIL ROAD MEDICARE
PA50060277OtherBC/BS OF PENNSYLVANIA
PA094578TGVMedicare ID - Type Unspecified
PAI41567Medicare UPIN