Provider Demographics
NPI:1720153208
Name:LAGUDU, ADINARAYANA M (MD)
Entity Type:Individual
Prefix:
First Name:ADINARAYANA
Middle Name:M
Last Name:LAGUDU
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 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-253-2900
Mailing Address - Fax:321-435-0100
Practice Address - Street 1:2200 W EAU GALLIE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3166
Practice Address - Country:US
Practice Address - Phone:321-253-2900
Practice Address - Fax:321-435-0100
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001Q04OtherBCBS
NM151870OtherAHCCCS NM
NM07900759Medicaid
NMP00378914OtherRRMDCR
NM7900759Medicaid
NM373702503Medicare PIN
NM07900759Medicaid
NM7900759Medicaid
NM343702503Medicare PIN