Provider Demographics
NPI:1164686853
Name:VULLI, NAGA JYOTHI (MD)
Entity type:Individual
Prefix:DR
First Name:NAGA
Middle Name:JYOTHI
Last Name:VULLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:STE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1605 N CEDAR CREST BLVD
Practice Address - Street 2:STE 110B
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2351
Practice Address - Country:US
Practice Address - Phone:610-973-1410
Practice Address - Fax:610-973-1449
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102685334Medicaid
PA236110Medicare PIN