Provider Demographics
NPI:1750498515
Name:MADDURI, MURTHY VENKATA (MD)
Entity Type:Individual
Prefix:DR
First Name:MURTHY
Middle Name:VENKATA
Last Name:MADDURI
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:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-355-0720
Mailing Address - Fax:704-355-5948
Practice Address - Street 1:601 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4331
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058013208M00000X
NC2008-02079208M00000X, 207R00000X
NC2008-152631208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N27530042OtherMEDICARE NO. MERCY
SCNC1754Medicaid
ON27530OtherMEDICARE GROUP NO. MERCY
NC1750498515OtherNPI
NC1750498515Medicaid
MI4233913Medicaid
NC5911484Medicaid
700F110460OtherBCBS GROUP NO. MERCY
700F110460OtherBCBS GROUP NO. MERCY
SCNC1754Medicaid
N27530042OtherMEDICARE NO. MERCY
NC1750498515Medicaid