Provider Demographics
NPI:1497868319
Name:MUDIAM, MADHUSUDHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHUSUDHAN
Middle Name:
Last Name:MUDIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LEBANON RD
Mailing Address - Street 2:ALVIN C YORK VAMC, PSYCHIATRY SERVICE
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1237
Mailing Address - Country:US
Mailing Address - Phone:615-867-6000
Mailing Address - Fax:615-225-5381
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:ALVIN C YORK VAMC, PSYCHIATRY SERVICE
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-893-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD296222084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry