Provider Demographics
NPI:1649230079
Name:TUMMALA, PADMAVATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAVATHY
Middle Name:
Last Name:TUMMALA
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 1:5757 W THUNDERBIRD RD STE W310
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4644
Mailing Address - Country:US
Mailing Address - Phone:602-393-2450
Mailing Address - Fax:602-393-2458
Practice Address - Street 1:5757 W THUNDERBIRD RD STE W310
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4644
Practice Address - Country:US
Practice Address - Phone:602-393-2450
Practice Address - Fax:602-393-2458
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21393207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628331OtherAETNA
AZ4238300OtherCIGNA
AZ07-00187OtherUNITED HEALTHCARE
AZ75736OtherPACIFICARE
AZ129454Medicaid
AZ1Z1233OtherHEALTHNET
AZ628331OtherAETNA
AZ129454Medicaid