Provider Demographics
NPI:1588857320
Name:VOODARLA, ANUPAMA (MD)
Entity type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:VOODARLA
Suffix:
Gender:
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1900
Mailing Address - Fax:239-424-1904
Practice Address - Street 1:1138 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3027
Practice Address - Country:US
Practice Address - Phone:239-424-1900
Practice Address - Fax:239-424-1904
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEIN THE PROCESS207R00000X, 208M00000X
CT046765207R00000X
FLME172827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL126240500Medicaid
CT001467653Medicaid
CTPENDING - C00814Medicare PIN