Provider Demographics
NPI:1417994302
Name:MADDATU, ROSE MYLAINE Q (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MYLAINE Q
Last Name:MADDATU
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:70 RAMTOWN GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3830
Mailing Address - Country:US
Mailing Address - Phone:732-785-0300
Mailing Address - Fax:732-785-9420
Practice Address - Street 1:70 RAMTOWN GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3830
Practice Address - Country:US
Practice Address - Phone:732-785-0300
Practice Address - Fax:732-785-9420
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA06047600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics