Healthcare Provider Details

I. General information

NPI: 1982912481
Provider Name (Legal Business Name): HIMABINDU MUDDANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINTHROP ST DR. BABU PEDIATRICS, PC
WORCESTER MA
01604-4435
US

IV. Provider business mailing address

25 OLD ORCHARD CIR
BOYLSTON MA
01505-1534
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3990
  • Fax:
Mailing address:
  • Phone: 508-869-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number925925
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247181
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: