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General NPI Number Information
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NPI Number | 1750543088
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Entity Type | Individual
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Provider Name | RICARDO ANDAYA MADDELA III D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 10 N LOCUST ST
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City | OXFORD
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State | OH
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Zip | 45056-1192
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Country | US
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Telephone | 513-853-9000
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Fax | 513-896-3727
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Provider Business Mailing Address
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Address Line | 10 N LOCUST ST
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City | OXFORD
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State | OH
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Zip | 45056-1192
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Country | US
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Telephone | 513-853-9000
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Fax | 513-896-3727
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 03288
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 34.016302
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License Number State | OH
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