Provider Demographics
NPI:1548209943
Name:MADDINENI, DURGA (MD)
Entity Type:Individual
Prefix:
First Name:DURGA
Middle Name:
Last Name:MADDINENI
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 1:4543 43RD ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2609
Mailing Address - Country:US
Mailing Address - Phone:718-392-2220
Mailing Address - Fax:718-392-1777
Practice Address - Street 1:4543 43RD ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2609
Practice Address - Country:US
Practice Address - Phone:718-392-2220
Practice Address - Fax:718-392-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02462119Medicaid
NYI00502Medicare UPIN