Healthcare Provider Details

I. General information

NPI: 1699017087
Provider Name (Legal Business Name): MADHAVI RAYAPUDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2134
US

IV. Provider business mailing address

PO BOX 3045
LEWISTON ME
04243-3045
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-6341
  • Fax:
Mailing address:
  • Phone: 513-502-8495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number279053
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: