Provider Demographics
NPI:1265738975
Name:GUNDLAPALLI, VINAY SAGAR (MD)
Entity type:Individual
Prefix:
First Name:VINAY
Middle Name:SAGAR
Last Name:GUNDLAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:199 MULLICA HILL RD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2655
Mailing Address - Country:US
Mailing Address - Phone:856-362-8898
Mailing Address - Fax:856-362-8903
Practice Address - Street 1:199 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062
Practice Address - Country:US
Practice Address - Phone:856-362-8898
Practice Address - Fax:856-362-8903
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10151800208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery