Healthcare Provider Details

I. General information

NPI: 1487196622
Provider Name (Legal Business Name): NORTHERN MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLOCK TOWER CMNS
BREWSTER NY
10509-4055
US

IV. Provider business mailing address

111 CLOCK TOWER CMNS
BREWSTER NY
10509-4055
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5187
  • Fax: 855-703-7570
Mailing address:
  • Phone: 845-279-5187
  • Fax: 855-703-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MADDIPOTI CHOUDRY
Title or Position: PRESIDENT
Credential: MD
Phone: 845-592-4915