1770331894 NPI number — MS. VENKARA RISHIKA DABBARA MD

Table of content: MS. VENKARA RISHIKA DABBARA MD (NPI 1770331894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770331894 NPI number — MS. VENKARA RISHIKA DABBARA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DABBARA
Provider First Name:
VENKARA RISHIKA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770331894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 W. SHERMAN AVE.
Provider Second Line Business Mailing Address:
BOX 93
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-641-8662
Provider Business Mailing Address Fax Number:
856-575-4944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 W. SHERMAN AVE.
Provider Second Line Business Practice Location Address:
BOX 93
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-641-8662
Provider Business Practice Location Address Fax Number:
856-575-4944
Provider Enumeration Date:
05/13/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com