Provider Demographics
NPI:1558326306
Name:PANGANAMAMULA, UMA R (MD)
Entity type:Individual
Prefix:
First Name:UMA
Middle Name:R
Last Name:PANGANAMAMULA
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 1:433 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4514
Mailing Address - Country:US
Mailing Address - Phone:609-394-4111
Mailing Address - Fax:609-394-4070
Practice Address - Street 1:433 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4501
Practice Address - Country:US
Practice Address - Phone:609-394-4111
Practice Address - Fax:609-394-4070
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08034500207V00000X
PAMD423455207V00000X
NJ25MA05034500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I12910Medicare UPIN