Provider Demographics
NPI:1043710833
Name:MADAVARAM, NAGENDER RAO
Entity Type:Individual
Prefix:
First Name:NAGENDER
Middle Name:RAO
Last Name:MADAVARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11417 HEATHER POINT PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-6330
Mailing Address - Country:US
Mailing Address - Phone:301-916-0303
Mailing Address - Fax:
Practice Address - Street 1:11417 HEATHER POINT PL
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-6330
Practice Address - Country:US
Practice Address - Phone:301-916-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker