Provider Demographics
NPI:1295001204
Name:PYDIMARRI, SUDHINDRA BABU (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHINDRA
Middle Name:BABU
Last Name:PYDIMARRI
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 1:2990 MACK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5384
Mailing Address - Country:US
Mailing Address - Phone:513-870-7800
Mailing Address - Fax:513-587-2931
Practice Address - Street 1:2990 MACK RD STE 107
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5384
Practice Address - Country:US
Practice Address - Phone:513-870-7800
Practice Address - Fax:513-587-2931
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.150473207R00000X
PAMD454257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine