Provider Demographics
NPI:1720033699
Name:ARUN, MATHOGANDAPALLY S (MD)
Entity Type:Individual
Prefix:
First Name:MATHOGANDAPALLY
Middle Name:S
Last Name:ARUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1348
Mailing Address - Country:US
Mailing Address - Phone:407-447-7121
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:501 WYNN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3445
Practice Address - Country:US
Practice Address - Phone:256-890-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD81599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL043690150OtherTAX ID
AL51510737OtherBC PROVIDER NUMBER
LAG16302Medicare UPIN
AL051552151Medicare ID - Type Unspecified