Dr. Koppula S Premachandra , MD
Pediatrics • Hackensack, NJ
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Koppula Premachandra has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Koppula Premachandra, MD was a registered Pediatrics practicing in Hackensack, NJ. Throughout an active medical career spanning 13 years, Dr. Premachandra provided care at the practice location at 30 PROSPECT AVE until profile deactivation on 2019-06-03.
Practice Location & Contact Primary Location
30 Prospect Ave
Hackensack, NJ 076011914
Specialty Benchmarks & Practice Insights
Comparative analytics for Pediatrics in Hackensack, NJ
Practicing in Hackensack, NJ (2321 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 208000000X
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Emergency Medicine
Doctor of Osteopathic Medicine (D.O.)
Nurse Practitioner - Family
APNC
Pediatrics
Doctor of Medicine (M.D.)
Social Worker
Licensed Social Worker
Pediatrics - Pediatric Emergency Medicine
Doctor of Medicine (M.D.)
Social Worker - Clinical
Licensed Clinical Social Worker
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on June 03, 2019
NPI status registered as active in NPPES database
Registered at 30 PROSPECT AVE, HACKENSACK, NJ 076011914 (Tel: 2019962000)
Registered at 38 E WHITE TER, NUTLEY, NJ 071101952
Recorded as KOPPULA PREMACHANDRA, MD
Pediatrics (License #25MA03892000 in NJ)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
38 E White Ter
Nutley, NJ 071101952
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