Provider Demographics
NPI:1467815043
Name:MADHAVAPEDDI, NAGA SAI VENKATA HANUMANTHA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGA SAI VENKATA
Middle Name:HANUMANTHA RAO
Last Name:MADHAVAPEDDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1120 W CAMPBELL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2978
Mailing Address - Country:US
Mailing Address - Phone:214-575-2663
Mailing Address - Fax:214-575-2664
Practice Address - Street 1:1120 W CAMPBELL RD STE 109
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2978
Practice Address - Country:US
Practice Address - Phone:214-575-2663
Practice Address - Fax:214-575-2664
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2023-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR4269207Q00000X, 207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program