Provider Demographics
NPI:1417114760
Name:MUPPIDI, JAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGAN
Middle Name:
Last Name:MUPPIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST # M-528
Mailing Address - Street 2:BOX 130
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-4749
Mailing Address - Fax:212-746-6692
Practice Address - Street 1:525 E 68TH ST # M-528
Practice Address - Street 2:BOX 130
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4749
Practice Address - Fax:212-746-6692
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine