Provider Demographics
NPI:1083948384
Name:SIDDESWARAPPA, MADHU (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:
Last Name:SIDDESWARAPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 OBERY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2237
Mailing Address - Country:US
Mailing Address - Phone:508-746-6385
Mailing Address - Fax:508-732-8724
Practice Address - Street 1:46 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2237
Practice Address - Country:US
Practice Address - Phone:508-746-6385
Practice Address - Fax:508-732-8724
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438146204F00000X
MA267143208600000X
NC2016-00513208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery