Provider Demographics
NPI:1174549331
Name:HEBBALALU, PRAPHULLA (MD)
Entity type:Individual
Prefix:
First Name:PRAPHULLA
Middle Name:
Last Name:HEBBALALU
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 1:214 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-4346
Mailing Address - Country:US
Mailing Address - Phone:732-750-5951
Mailing Address - Fax:
Practice Address - Street 1:15 CAMPUS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3200
Practice Address - Country:US
Practice Address - Phone:484-454-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07997600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI50070Medicare UPIN