MEDICARE: NARALA AND MADIREDDY MD A PROFESSIONAL CORPORATION

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	207R00000X	Internal Medicine Physician	A51491	CA
2	207R00000X	Internal Medicine Physician	A51494	CA
3	208000000X	Pediatrics Physician	A51491	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GR0077500	OTHER	CA	CHDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063409167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NARALA AND MADIREDDY MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	568 E HERNDON AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2989
Country	:	US
Telephone Number	:	559-224-7990
Fax Number	:	559-224-5617

Provider Business Practice Location Address
First Line	:	568 E HERNDON AVE
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93720-2989
Country	:	US
Telephone Number	:	559-224-7990
Fax Number	:	559-224-5617

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. NAGARATNAMMA MADIREDDY
Credential	:	M.D.
Telephone Number	:	559-224-7990

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	06/13/2019

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