Provider Demographics
NPI:1730196478
Name:MAMIDI, ARUNIMA (MD)
Entity type:Individual
Prefix:
First Name:ARUNIMA
Middle Name:
Last Name:MAMIDI
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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BLAWENBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08504
Mailing Address - Country:US
Mailing Address - Phone:609-371-4666
Mailing Address - Fax:609-443-4800
Practice Address - Street 1:5 PLAINSBORO ROAD
Practice Address - Street 2:SUITE 360
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-750-0011
Practice Address - Fax:609-750-0022
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068633207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
J31841OtherHEALTHNET
NJ7947607Medicaid
2227114001OtherKEYSTONE
60006502OtherHORIZON NJ HEALTH
60006502OtherHORIZON NJ HEALTH
NJ025981Medicare ID - Type Unspecified