Provider Demographics
NPI:1699075127
Name:GUMIDYALA, PADMASREE (MD, MPH)
Entity type:Individual
Prefix:MRS
First Name:PADMASREE
Middle Name:
Last Name:GUMIDYALA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 INMAN AVENUE
Mailing Address - Street 2:SUITE 1-A, ABC PEDIATRICS
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:908-412-8866
Mailing Address - Fax:908-412-9363
Practice Address - Street 1:974 INMAN AVENUE
Practice Address - Street 2:SUITE 1-A, ABC PEDIATRICS
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-412-8866
Practice Address - Fax:908-412-9363
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08850000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics