MEDICARE: PARWATI MADDALI MD PROFESSIONAL ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0066568	FL

General Provider Information

NPI Number	:	1184745788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARWATI MADDALI MD PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 561527
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32956-1527
Country	:	US
Telephone Number	:	321-631-4222
Fax Number	:	321-631-4302

Provider Business Practice Location Address
First Line	:	845 EXECUTIVE LN
Second Line	:	100
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-3528
Country	:	US
Telephone Number	:	321-631-4222
Fax Number	:	321-631-4302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PARWATI C MADDALI
Credential	:	MD
Telephone Number	:	321-631-4222

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	10/10/2013

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