Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MAO71431 | NJ |
Y | 111NI0900X | Internist | MAO71431 | NJ |
N | 208000000X | Pediatrician | MAO71431 | NJ |
NPI | 1003867607 |
---|---|
Provider Name | Dr. Kausalya Chennapragada |
First Address | Woodland Park, NJ 07424-2559 |
Second Address | Woodland Park, NJ 07424-2559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H53175 | (02) |