Provider Demographics
NPI:1609954429
Name:MADDELA, EVELYN B (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:B
Last Name:MADDELA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4770 W HERNDON AVE
Mailing Address - Street 2:108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8401
Mailing Address - Country:US
Mailing Address - Phone:559-256-7990
Mailing Address - Fax:559-256-7991
Practice Address - Street 1:4770 W HERNDON AVE
Practice Address - Street 2:108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8401
Practice Address - Country:US
Practice Address - Phone:559-256-7990
Practice Address - Fax:559-256-7991
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC42730208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F28038Medicare UPIN