Basic Information
| Provider Information | |||||||||
| NPI: | 1467641084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VADLAKONDA | ||||||||
| FirstName: | NIRUPAMA | ||||||||
| MiddleName: | DEVI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12201 PLUM ORCHARD DR | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209047803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015721000 | ||||||||
| FaxNumber: | 3015723302 | ||||||||
| Practice Location | |||||||||
| Address1: | 12201 PLUM ORCHARD DR | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209047803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015721000 | ||||||||
| FaxNumber: | 3015723302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D64583 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 580223700 | 05 | MD | MEDICAID |