Provider Demographics
NPI:1790936193
Name:PRATTIPATI, MADHU SRINIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:SRINIVAS
Last Name:PRATTIPATI
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 1:200 BANNING ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-744-9645
Mailing Address - Fax:302-744-9649
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE 210
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-744-9645
Practice Address - Fax:302-744-9649
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine