Provider Demographics
NPI:1487662011
Name:MADDELA, ZENAIDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ZENAIDA
Middle Name:A
Last Name:MADDELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 N ELM ST STE 206
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2767
Mailing Address - Country:US
Mailing Address - Phone:270-826-9595
Mailing Address - Fax:270-826-3656
Practice Address - Street 1:1413 N ELM ST STE 206
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2767
Practice Address - Country:US
Practice Address - Phone:270-826-9595
Practice Address - Fax:270-826-3656
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64193147Medicaid
KY1535501Medicare UPIN
C69724Medicare UPIN
KY64193147Medicaid
KY080113179Medicare ID - Type UnspecifiedKY RR MCR