Provider Demographics
NPI:1053489336
Name:EDAPPULLY, JOHNY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNY
Middle Name:JOSEPH
Last Name:EDAPPULLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3416 OLANDWOOD CT
Mailing Address - Street 2:207
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1372
Mailing Address - Country:US
Mailing Address - Phone:301-774-8355
Mailing Address - Fax:301-774-1231
Practice Address - Street 1:3416 OLANDWOOD CT
Practice Address - Street 2:207
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1372
Practice Address - Country:US
Practice Address - Phone:301-774-8355
Practice Address - Fax:301-774-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0037830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E40799Medicare UPIN
599063F96Medicare ID - Type Unspecified