1891109690 NPI number — NARASA RAJU MADAM M.B.B.S

Table of content: JAMIE F MARKKO (NPI 1588556385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891109690 NPI number — NARASA RAJU MADAM M.B.B.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADAM
Provider First Name:
NARASA
Provider Middle Name:
RAJU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S
Provider Gender Code:
M

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:
1891109690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SANTOSH NAGAR, MEHDIPATNAM
Provider Second Line Business Mailing Address:
4.NO.12-2-823/5/301
Provider Business Mailing Address City Name:
HYDERABAD
Provider Business Mailing Address State Name:
BALAJI ARCADE
Provider Business Mailing Address Postal Code:
500028
Provider Business Mailing Address Country Code:
IN
Provider Business Mailing Address Telephone Number:
919581411995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14633 HERITAGE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-476-2006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2014

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: 207R00000X , with the licence number:  53294 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 53294 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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