Provider Demographics
NPI:1588730212
Name:CHOLANKERIL, MARY G (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:CHOLANKERIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:G
Other - Last Name:CHOLANKERIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:STE 205
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207
Mailing Address - Country:US
Mailing Address - Phone:908-289-2070
Mailing Address - Fax:908-289-4890
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:STE 205
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07207
Practice Address - Country:US
Practice Address - Phone:908-289-2070
Practice Address - Fax:908-289-4890
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0389900207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2105306Medicaid
D96849Medicare UPIN
NJ456516Medicare ID - Type Unspecified