Provider Demographics
NPI:1245422328
Name:JAGARLAMUDI, PADMAVATHI (MD)
Entity Type:Individual
Prefix:
First Name:PADMAVATHI
Middle Name:
Last Name:JAGARLAMUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 FULTON AVENUE
Mailing Address - Street 2:FULTON FAMILY HEALTH CENTER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3499
Mailing Address - Country:US
Mailing Address - Phone:718-901-6275
Mailing Address - Fax:718-901-8589
Practice Address - Street 1:1276 FULTON AVENUE
Practice Address - Street 2:FULTON FAMILY HEALTH CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3499
Practice Address - Country:US
Practice Address - Phone:718-901-6275
Practice Address - Fax:718-901-8589
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00438928OtherRAIL ROAD MEDICARE
AZ251796Medicaid
AZ251796Medicaid
AZ117422Medicare PIN
AZ117421Medicare PIN
AZ117424Medicare PIN