Provider Demographics
NPI:1871737155
Name:GONDIPALLI, PRATIMA R (MD)
Entity type:Individual
Prefix:DR
First Name:PRATIMA
Middle Name:R
Last Name:GONDIPALLI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:175 N PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1049
Practice Address - Country:US
Practice Address - Phone:973-404-9700
Practice Address - Fax:973-377-4709
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA11115200207L00000X
VA0101268313207L00000X
NY248078207L00000X
IL036.120727207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology