Provider Demographics
NPI:1831473859
Name:ANITHA MANDADAPU, MD, PLLC
Entity type:Organization
Organization Name:ANITHA MANDADAPU, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDADAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-817-0927
Mailing Address - Street 1:3905 SPRING VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5121
Mailing Address - Country:US
Mailing Address - Phone:502-817-0927
Mailing Address - Fax:502-222-8745
Practice Address - Street 1:8521 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-3800
Practice Address - Country:US
Practice Address - Phone:502-817-0927
Practice Address - Fax:502-222-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty