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General NPI Number Information
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NPI Number | 1316480049
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Entity Type | Organization
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Legal Business Name | MOBILE MD LLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 160 HAROLD FLEMING CT
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City | SPARTANBURG
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State | SC
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Zip | 29303-4226
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Country | US
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Telephone | 864-594-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 325 HANSA LN
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City | GREER
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State | SC
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Zip | 29650-4549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RAJA PALADUGU
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Credential | M.D.
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Telephone | 864-436-1021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19705
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 19254
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License Number State | SC
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