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NPI Code Detail

MEDICARE: NORTHERN MEDICAL GROUP, PLLC

MEDICARE: NORTHERN MEDICAL GROUP, PLLC
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
1207R00000XInternal Medicine Physician
2207RC0001XClinical Cardiac Electrophysiology Physician
3207RE0101XEndocrinology, Diabetes & Metabolism Physician
4207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487196622
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN MEDICAL GROUP, PLLC
Provider Business Mailing Address
First Line : 111 CLOCK TOWER CMNS
Second Line :
City : BREWSTER
State : NY
Zip : 10509-4055
Country : US
Telephone Number : 845-279-5187
Fax Number : 855-703-7570
Provider Business Practice Location Address
First Line : 111 CLOCK TOWER CMNS
Second Line :
City : BREWSTER
State : NY
Zip : 10509-4055
Country : US
Telephone Number : 845-279-5187
Fax Number : 855-703-7570
Authorized Official
Title or Position : PRESIDENT
Name : MADDIPOTI CHOUDRY
Credential : MD
Telephone Number : 845-592-4915
Provider Enumeration Date : 11/04/2016
Last Update Date : 01/28/2026

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1174994826 — NORTHERN MEDICAL GROUP, PLLC
Practice Location Address:
111 CLOCK TOWER CMNS
BREWSTER, NY
10509-4055
Practice Phone: 845-592-4915
Practice Fax: 845-592-4914

Directions to “NORTHERN MEDICAL GROUP, PLLC ” Practice Location

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