MEDICARE: PADMAVATHI JONNALAGADDA 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	207R00000X	Internal Medicine Physician	25MA07442900	NJ
2	207R00000X	Internal Medicine Physician	225330-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB2462	OTHER	NJ	RAILROAD MEDICARE GROUP #
6	P00089969	OTHER	NJ	RAILROAD MEDICARE INDIVID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	043714808	OTHER	NJ	HORIZON B/ C B/S
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144228891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PADMAVATHI JONNALAGADDA MD

Provider Business Mailing Address
First Line	:	3438 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4166
Country	:	US
Telephone Number	:	201-420-0366
Fax Number	:	201-420-6422

Provider Business Practice Location Address
First Line	:	3438 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4166
Country	:	US
Telephone Number	:	201-420-0366
Fax Number	:	201-420-6422

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/25/2012

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