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General NPI Number Information
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NPI Number | 1326060435
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Entity Type | Individual
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Provider Name | SRINIVASA RAO MANDADAPU M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 10027 SANDBAR DR
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City | IRVING
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State | TX
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Zip | 75063-5098
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Country | US
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Telephone | 469-877-8437
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Fax |
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Provider Business Mailing Address
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Address Line | 10027 SANDBAR DR
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City | IRVING
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State | TX
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Zip | 75063-5098
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Country | US
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Telephone | 469-877-8437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME139995
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME139995
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L8121
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License Number State | TX
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