Basic Information
| Provider Information | |||||||||
| NPI: | 1134407547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUJJULA | ||||||||
| FirstName: | PRASHANTHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 3322 ROUTE 22 STE 1204 | ||||||||
| Address2: | |||||||||
| City: | BRANCHBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088764407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083787227 | ||||||||
| FaxNumber: | 9082520127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA10257300 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.