Provider Demographics
NPI:1730169632
Name:CHEELA, SANTHOSH K (MD)
Entity type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:K
Last Name:CHEELA
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 1:200 PERRINE RD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-525-0200
Mailing Address - Fax:732-525-0275
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE #208
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-525-0200
Practice Address - Fax:732-525-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53855207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA62094Medicare UPIN