Provider Demographics
NPI:1205399805
Name:MOPURI, NAGASASIKANTH R (MD,MBA,MHA)
Entity type:Individual
Prefix:DR
First Name:NAGASASIKANTH
Middle Name:R
Last Name:MOPURI
Suffix:
Gender:M
Credentials:MD,MBA,MHA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2151 NJ ROUTE 38
Mailing Address - Street 2:APT # 902 E
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:888-575-9162
Mailing Address - Fax:980-987-4391
Practice Address - Street 1:103 OLD MARLTON PIKE STE 124
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:888-575-9162
Practice Address - Fax:980-987-4391
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD479640208M00000X
NJ25MA1114270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist