Provider Demographics
NPI:1891731881
Name:MADAIAH, SUGUNA DEVI (MD)
Entity Type:Individual
Prefix:
First Name:SUGUNA
Middle Name:DEVI
Last Name:MADAIAH
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:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-521-8200
Mailing Address - Fax:479-582-7310
Practice Address - Street 1:3344 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-521-8200
Practice Address - Fax:479-582-7310
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00211359OtherRR MCR
AR5M543OtherAR BC/BS
ARP00211359OtherRR MCR
ARH81974Medicare UPIN
AR5M543OtherAR BC/BS