Provider Demographics
NPI:1336139443
Name:GOGINENI, MADHURI (MD)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:GOGINENI
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 1:15 W 18TH ST
Mailing Address - Street 2:5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4624
Mailing Address - Country:US
Mailing Address - Phone:321-961-1181
Mailing Address - Fax:646-329-6397
Practice Address - Street 1:748 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2220
Practice Address - Country:US
Practice Address - Phone:231-627-1438
Practice Address - Fax:231-627-1471
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37313ZMedicare ID - Type Unspecified
H28735Medicare UPIN