Provider Demographics
NPI:1205810926
Name:MARULENDRA, SHIVAPRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVAPRASAD
Middle Name:
Last Name:MARULENDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TARA WAY
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2100
Mailing Address - Country:US
Mailing Address - Phone:609-477-3003
Mailing Address - Fax:
Practice Address - Street 1:27 TARA WAY
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2100
Practice Address - Country:US
Practice Address - Phone:609-477-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06405900174400000X, 207RG0100X
IL036141750207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010002878-00OtherAMERICHOICE
NJ4651687OtherAETNAPPO
NJ869482OtherAMERIHEALTH PPO
NH222233588OtherMULTIPLAN
IL214881OtherMEDICARE GROUP PTAN
NH3977218008OtherCIGNA
NJ0000653760001OtherONE HEALTH PLAN
NJ1091534OtherHORIZON NJ HEALTH
NJ7050607Medicaid
NH744595OtherFIRST HEALTH
NH0985179000OtherAMERIHEALTH HMO
NJ143398OtherCHN
NJ16536OtherAMERICAID
NJ2172624OtherAETNA HMO
NJ222233588OtherHORIZON BC/BS
NJ2K7529OtherHEALTHNET
NH28B141OtherEMPIRE HEALTH CARE
NJ5711065OtherGHI
NJ63162OtherLOCAL 825 PPO
NH222233588OtherMULTIPLAN
NJMA869482Medicare PIN