Provider Demographics
NPI:1952531899
Name:MADISI, NIRA AMRITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRA
Middle Name:AMRITA
Last Name:MADISI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:POB 3RD FLOOR
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-257-5777
Practice Address - Street 1:800 N DUPONT BLVD
Practice Address - Street 2:BAYHEALTH PHYSICIANS
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1019
Practice Address - Country:US
Practice Address - Phone:302-422-1251
Practice Address - Fax:302-424-6513
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2017-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDP24017207R00000X
390200000X
DEC1-0011215207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE417028ZA5HMedicare PIN