Healthcare Provider Details

I. General information

NPI: 1578877064
Provider Name (Legal Business Name): MARAPPA GOWNDER NALLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 06/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON ROAD ATTN BMG HOSPITALIST TEAM/AMANDA GUMP
MESA AZ
85202
US

IV. Provider business mailing address

1400 S DOBSON ROAD ATTN BMG HOSPITALIST TEAM/AMANDA GUMP
MESA AZ
85202
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-6788
  • Fax: 480-412-6848
Mailing address:
  • Phone: 480-412-6788
  • Fax: 480-412-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT197921
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62042
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62042
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: