Provider Demographics
NPI:1235681537
Name:NORTHERN MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:NORTHERN MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADDIPOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-279-5187
Mailing Address - Street 1:111 CLOCK TOWER CMNS
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-279-5187
Mailing Address - Fax:845-279-5168
Practice Address - Street 1:159 BARNEGAT RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5401
Practice Address - Country:US
Practice Address - Phone:845-452-9800
Practice Address - Fax:845-279-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100141226Medicare PIN