Doctor Name: | DR. SRUJANA REDDY MADDERLA |
NPI Number: | 1083021273 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D |
License Number: | |
Business Practice Address: | 1 Atwell Rd Cooperstown, NY - 133261301 |
Business Phone Number: | 6075473456 |
Business Fax Number: | 6075476612 |
Mailing Address: | Po Box 725, COOPERSTOWN |
State: | NY |
Postal Code: | 133260725 |
Phone Number: | 6075473456 |
Fax Number: | 6075476612 |
NPI Enumeration Date: | 07/19/2014 |
NPI Last Update Date: | 07/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |