Provider Demographics
NPI:1437530003
Name:MADALA, SUSHMA
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:MADALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSHMA
Other - Middle Name:
Other - Last Name:VELCHURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510
Mailing Address - Country:US
Mailing Address - Phone:570-343-2383
Mailing Address - Fax:
Practice Address - Street 1:501 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510
Practice Address - Country:US
Practice Address - Phone:570-343-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209306207R00000X
VA0101263825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine