Provider Demographics
NPI:1689646390
Name:MADAMALA, PRAMEELA (MD)
Entity Type:Individual
Prefix:
First Name:PRAMEELA
Middle Name:
Last Name:MADAMALA
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 1:151 CALDERON AVE
Mailing Address - Street 2:#144
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1463
Mailing Address - Country:US
Mailing Address - Phone:650-969-2907
Mailing Address - Fax:
Practice Address - Street 1:151 CALDERON AVE
Practice Address - Street 2:#144
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1463
Practice Address - Country:US
Practice Address - Phone:650-969-2907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C9051Medicare ID - Type Unspecified
TXI22426Medicare UPIN