Provider Demographics
NPI:1497797708
Name:PADDU, PADMANABH U (MD)
Entity Type:Individual
Prefix:
First Name:PADMANABH
Middle Name:U
Last Name:PADDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PADMANABH
Other - Middle Name:U
Other - Last Name:PADDU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4902 QUEENS BLVD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4444
Mailing Address - Country:US
Mailing Address - Phone:718-784-4502
Mailing Address - Fax:718-784-5180
Practice Address - Street 1:4902 QUEENS BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4444
Practice Address - Country:US
Practice Address - Phone:718-784-4502
Practice Address - Fax:718-784-5180
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135522207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE42394Medicare UPIN