MEDICARE: DEBAROTI M ADDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	L3216	TX

General Provider Information

NPI Number	:	1023016235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBAROTI M ADDY MD

Provider Business Mailing Address
First Line	:	8327 LOFTY LN
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-3466
Country	:	US
Telephone Number	:	512-244-2645
Fax Number	:

Provider Business Practice Location Address
First Line	:	15930 S GREAT OAKS DR
Second Line	:	BUILDING B
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5526
Country	:	US
Telephone Number	:	512-255-8868
Fax Number	:	512-255-8869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/09/2007

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