Provider Demographics
NPI:1972105401
Name:VRL MEDICAL PRACTICE PLLC
Entity type:Organization
Organization Name:VRL MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAGA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-284-5398
Mailing Address - Street 1:300 WELSH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2248
Mailing Address - Country:US
Mailing Address - Phone:215-284-5398
Mailing Address - Fax:
Practice Address - Street 1:1425 HORSHAM RD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1320
Practice Address - Country:US
Practice Address - Phone:215-284-5398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty