Provider Demographics
NPI:1700013943
Name:KAMBAM, MADHAVI LATHA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI LATHA
Middle Name:REDDY
Last Name:KAMBAM
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 1:43 NEW SCOTLAND AVE
Mailing Address - Street 2:MAIL CODE 7
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-6696
Mailing Address - Fax:518-262-6770
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:MC 7
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271085207RH0003X
MA242060207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01295946OtherRAILROAD MEDICARE
NY03654299Medicaid
NYA400091184Medicare PIN
NYP01295946OtherRAILROAD MEDICARE