Provider Demographics
NPI:1548374853
Name:NERURKAR, MEENA ANIL (MD)
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:ANIL
Last Name:NERURKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4324
Mailing Address - Country:US
Mailing Address - Phone:215-322-6220
Mailing Address - Fax:215-322-7443
Practice Address - Street 1:4 ROSE AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4324
Practice Address - Country:US
Practice Address - Phone:215-322-6220
Practice Address - Fax:215-322-7443
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0225158E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41629Medicare UPIN