Basic Information
| Provider Information | |||||||||
| NPI: | 1912912585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOINAPALLY | ||||||||
| FirstName: | NIVEDITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172174300 | ||||||||
| FaxNumber: | 7172174399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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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 | MD071648L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | MD071648L | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 039277 | 01 | PA | JOHNS HOPKINS | OTHER | 02113702 | 01 | PA | CAPITAL BC-WMG YFM | OTHER | 607889 | 01 | MD | CAREFIRST MD BCBS | OTHER | 202294 | 01 | PA | UNISON-WMG READYCARE | OTHER | 50066448 | 01 | PA | CAPITAL BC-WMG READYCARE | OTHER | 777707 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 7781478 | 01 | PA | AETNA | OTHER | 2161250 | 01 | PA | MAMSI-WMG READYCARE | OTHER | 65738 | 01 | PA | GEISINGER | OTHER | 50063724 | 01 | PA | CAPITAL BC-WMG CFA | OTHER | P002815 | 01 | PA | GATEWAY-WMG | OTHER | 001811880 | 05 | PA | MEDICAID | 20064069 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 1142408 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 193126 | 01 | PA | UNISON-WMG CFA | OTHER | 110500 | 01 | PA | UNISON-WMG YFM | OTHER | 283462 | 01 | PA | MAMSI-WMG | OTHER |