=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356492433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADHURI DEVI GADIYARAM M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 07/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 390 AMWELL RD STE 204
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 82-622-1979
-----------------------------------------------------
Fax | 908-262-2195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 826 TERNAY AVE
-----------------------------------------------------
City | SCOTCH PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07076-2150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-481-9467
-----------------------------------------------------
Fax | 908-262-2195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 242255
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA09756200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------