Provider Demographics
NPI:1720203565
Name:BABURAO DODDAPANENI MD PC
Entity Type:Organization
Organization Name:BABURAO DODDAPANENI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BABURAO
Authorized Official - Middle Name:
Authorized Official - Last Name:DODDAPANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-499-4995
Mailing Address - Street 1:4 UNADILLA PL
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-3010
Mailing Address - Country:US
Mailing Address - Phone:718-499-4995
Mailing Address - Fax:718-897-7330
Practice Address - Street 1:3626 MAIN ST
Practice Address - Street 2:STE 3X
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4274
Practice Address - Country:US
Practice Address - Phone:718-358-2135
Practice Address - Fax:718-886-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161503207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty