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General NPI Number Information
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NPI Number | 1316978745
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Entity Type | Organization
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Legal Business Name | MAMIDI CARDIOLOGY PLLC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20 HOSPITAL DR
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City | LOGAN
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State | WV
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Zip | 25601
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Country | US
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Telephone | 304-831-2300
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Fax | 304-831-2303
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Provider Business Mailing Address
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Address Line | 20 HOSPITAL DR
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City | LOGAN
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State | WV
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Zip | 25601
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Country | US
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Telephone | 304-831-2300
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Fax | 304-831-2303
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Authorized Official
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Title or Position | OWNER
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Name | SATYANARAYANA MAMIDI
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Credential | MD
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Telephone | 304-831-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | WV12853
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License Number State | WV
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