Provider Demographics
NPI:1619057379
Name:NALLA, SUMITHRA (MD)
Entity type:Individual
Prefix:
First Name:SUMITHRA
Middle Name:
Last Name:NALLA
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 1:1105 LAUREL OAK RD STE 165
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4312
Mailing Address - Country:US
Mailing Address - Phone:856-374-4440
Mailing Address - Fax:856-325-5734
Practice Address - Street 1:1105 LAUREL OAK RD STE 165
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4312
Practice Address - Country:US
Practice Address - Phone:856-374-4440
Practice Address - Fax:856-325-5734
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12870100207RN0300X, 207R00000X
PAMD430094207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278000OtherMEDICAID GROUP TPI
PACD4829OtherRAILROAD MEDICARE TPI GROUP
PA597586OtherMEDICARE GROUP TPI