Provider Demographics
NPI:1336253152
Name:MADATHANAPALLI, PADMAVATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAVATHI
Middle Name:
Last Name:MADATHANAPALLI
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 1:1532 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1823
Mailing Address - Country:US
Mailing Address - Phone:510-351-6363
Mailing Address - Fax:510-278-3757
Practice Address - Street 1:1532 150TH AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1823
Practice Address - Country:US
Practice Address - Phone:510-351-6363
Practice Address - Fax:510-278-3757
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI03275Medicare UPIN