Provider Demographics
NPI:1174720304
Name:REMADEVI, RADHIKA S (MD)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:S
Last Name:REMADEVI
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 1:1129 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7127
Mailing Address - Country:US
Mailing Address - Phone:973-500-2686
Mailing Address - Fax:973-500-2686
Practice Address - Street 1:1129 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7127
Practice Address - Country:US
Practice Address - Phone:973-500-2686
Practice Address - Fax:973-500-2686
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08661900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3798359000OtherAMERIHEALTH
NJ3798359000OtherAMERIHEALTH