Provider Demographics
NPI:1669664447
Name:NAIDU, JAI P IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JAI
Middle Name:P
Last Name:NAIDU
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:91 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-268-2594
Mailing Address - Fax:
Practice Address - Street 1:37 PRATT AVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-268-2594
Practice Address - Fax:570-265-2328
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037174L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35017Medicare UPIN