Provider Demographics
NPI:1558541128
Name:AKKINENI, PADMAJA (MD)
Entity Type:Individual
Prefix:
First Name:PADMAJA
Middle Name:
Last Name:AKKINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMAJA
Other - Middle Name:
Other - Last Name:GOGINENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7612 MEMPHIS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3988
Mailing Address - Country:US
Mailing Address - Phone:214-862-2978
Mailing Address - Fax:972-767-3232
Practice Address - Street 1:5757 WARREN PKWY
Practice Address - Street 2:SUITE# 208
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:972-791-8225
Practice Address - Fax:972-767-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1457207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1792236-02Medicaid
TX1792236-02Medicaid