Provider Demographics
NPI:1548363880
Name:MURALIDHARAN, SOUNDARI (MD)
Entity type:Individual
Prefix:
First Name:SOUNDARI
Middle Name:
Last Name:MURALIDHARAN
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 1:970 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3502
Mailing Address - Country:US
Mailing Address - Phone:732-206-8900
Mailing Address - Fax:732-836-6001
Practice Address - Street 1:970 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3502
Practice Address - Country:US
Practice Address - Phone:732-206-8900
Practice Address - Fax:732-836-6001
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05943100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5609402Medicaid
NJF70116Medicare UPIN
NJ5609402Medicaid