Provider Demographics
NPI:1467659656
Name:BATHULA, VIKRAM K (MD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:K
Last Name:BATHULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DRIVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3500
Practice Address - Fax:856-365-4088
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD432895207R00000X
MI4301083907207R00000X
NJ25MA08490700208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278000OtherMEDICAID GROUP TPI
PA597586OtherMEDICARE GROUP TPI
PACD4829OtherRAILROAD MEDICARE TPI GROUP