Provider Demographics
NPI:1609142355
Name:TUMMALA, NEELIMA
Entity type:Individual
Prefix:
First Name:NEELIMA
Middle Name:
Last Name:TUMMALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S ST NW APT 503
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5985
Mailing Address - Country:US
Mailing Address - Phone:678-520-8738
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DR STE 420
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5901
Practice Address - Country:US
Practice Address - Phone:571-313-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264596207Y00000X
DCMD046396207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology