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General NPI Number Information
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NPI Number | 1376552901
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Entity Type | Individual
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Provider Name | MANGADHARA RAO MADINEEDI MD, MSA, FACP
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 940 BELMONT ST GERIATRICS & EXTENDED CARE SERVICE LINE (181)
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone | 774-826-1860
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Fax | 774-826-2643
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Provider Business Mailing Address
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Address Line | 940 BELMONT ST
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone | 508-583-4500
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Fax | 774-826-3157
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 79686
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License Number State | MA
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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 | 79686
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License Number State | MA
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