Provider Demographics
NPI:1710198544
Name:GADDAM, MADHAVI (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:GADDAM
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 1:2245 BRINKER RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6175
Mailing Address - Country:US
Mailing Address - Phone:940-488-4767
Mailing Address - Fax:877-795-8358
Practice Address - Street 1:3300 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-488-4767
Practice Address - Fax:855-444-9702
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27194207R00000X
TXN3040207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205024703Medicaid
TX205024701Medicaid
TXP00691956OtherRAILROAD MEDICARE NUMBER
TX205024702Medicaid
TXP00838701OtherRAILROAD MEDICARE
TXTXB133516Medicare PIN
TXP00838701OtherRAILROAD MEDICARE
TXP00691956OtherRAILROAD MEDICARE NUMBER