Provider Demographics
NPI:1487196622
Name:NORTHERN MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:NORTHERN MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADDIPOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-592-4915
Mailing Address - Street 1:159 BARNEGAT RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5454
Mailing Address - Country:US
Mailing Address - Phone:845-592-4915
Mailing Address - Fax:845-592-4914
Practice Address - Street 1:822 ROUTE 82
Practice Address - Street 2:SUITE 110
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-7373
Practice Address - Country:US
Practice Address - Phone:845-592-4915
Practice Address - Fax:845-592-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, PodiatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100141226Medicare PIN