Provider Demographics
NPI:1720168123
Name:MADDURI, NIRUPAMA (MD)
Entity Type:Individual
Prefix:
First Name:NIRUPAMA
Middle Name:
Last Name:MADDURI
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 1:301 W HUNTINGTON DR
Mailing Address - Street 2:327
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-447-8138
Mailing Address - Fax:626-447-2094
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:327
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-447-8138
Practice Address - Fax:626-447-2094
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171552601Medicaid
8D3380Medicare ID - Type Unspecified
TX171552601Medicaid