Provider Demographics
NPI:1992732135
Name:BUPATHI, KAVITA K (MD)
Entity type:Individual
Prefix:
First Name:KAVITA
Middle Name:K
Last Name:BUPATHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 WOODBRIDGE CENTER
Mailing Address - Street 2:SUITE #405
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095
Mailing Address - Country:US
Mailing Address - Phone:732-326-0363
Mailing Address - Fax:732-326-0365
Practice Address - Street 1:1 WOODBRIDGE CENTER
Practice Address - Street 2:SUITE 405
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-650-0350
Practice Address - Fax:732-650-0354
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMAO69857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8054401Medicaid
H11195Medicare UPIN
NJ8054401Medicaid