Healthcare Provider Details

I. General information

NPI: 1770826174
Provider Name (Legal Business Name): ANURADHA NARAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 LINDEN BOULEVARD BRISTOL FAMILY CARE CENTER
BROOKLYN NY
11212
US

IV. Provider business mailing address

1 BROOKDALE PLAZA PHYSICIAN ENTERPRISE
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5071
  • Fax: 718-240-5808
Mailing address:
  • Phone: 718-240-7143
  • Fax: 718-240-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0010547
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: