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General NPI Number Information
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NPI Number | 1497797708
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Entity Type | Individual
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Provider Name | PADMANABH U PADDU MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 4902 QUEENS BLVD LOWER LEVEL
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City | WOODSIDE
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State | NY
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Zip | 11377-4444
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Country | US
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Telephone | 718-784-4502
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Fax | 718-784-5180
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Provider Business Mailing Address
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Address Line | 4902 QUEENS BLVD LOWER LEVEL
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City | WOODSIDE
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State | NY
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Zip | 11377-4444
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Country | US
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Telephone | 718-784-4502
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Fax | 718-784-5180
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 135522
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License Number State | NY
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