Provider Demographics
NPI:1306178496
Name:MADADI, PAVAN KIRAN
Entity Type:Individual
Prefix:
First Name:PAVAN
Middle Name:KIRAN
Last Name:MADADI
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 1:1725 PINE ST
Mailing Address - Street 2:JACKSON HOSPITAL
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1109
Mailing Address - Country:US
Mailing Address - Phone:334-293-8067
Mailing Address - Fax:954-367-8512
Practice Address - Street 1:1725 PINE ST
Practice Address - Street 2:JACKSON HOSPITAL
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1109
Practice Address - Country:US
Practice Address - Phone:334-293-8067
Practice Address - Fax:954-367-8512
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine