Provider Demographics
NPI:1326153875
Name:GOVINDARAJU MADHIRAJU M.D., P.A.
Entity Type:Organization
Organization Name:GOVINDARAJU MADHIRAJU M.D., P.A.
Other - Org Name:GOVIND MADHIRAJU M.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MADHIRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-686-3931
Mailing Address - Street 1:201 BALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3632
Mailing Address - Country:US
Mailing Address - Phone:410-686-3931
Mailing Address - Fax:410-686-3932
Practice Address - Street 1:201 BALLARD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3632
Practice Address - Country:US
Practice Address - Phone:410-686-3931
Practice Address - Fax:410-686-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKCE8OtherBLUE CROSS/BLUE SHIELD
MDR103OtherBLUE CHOICE
MDR103OtherBLUE CHOICE
MD=========OtherCOVENTRY
MD=========OtherPHCS