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General NPI Number Information
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NPI Number | 1427629716
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Entity Type | Individual
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Provider Name | MOULIKA REDDY BANDARU MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 101 CLINIC DR
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City | TARBORO
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State | NC
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Zip | 27886-1935
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Country | US
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Telephone | 252-823-2105
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Fax | 252-823-3164
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Provider Business Mailing Address
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Address Line | 101 CLINIC DR
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City | TARBORO
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State | NC
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Zip | 27886-1935
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Country | US
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Telephone | 252-823-2105
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Fax | 252-823-3164
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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 | 2024-01130
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License Number State | NC
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