MEDICARE: DR. NAGARATNAMMA MADIREDDY M.D.

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	207R00000X	Internal Medicine Physician	A51491	CA
2	208000000X	Pediatrics Physician	A51491	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	GR0077500	OTHER	CA	CHDP PROVIDER NUMBER
3	A51491	OTHER	CA	STATE LICENSE NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356337505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGARATNAMMA MADIREDDY M.D.

Provider Business Mailing Address
First Line	:	568 E HERNDON AVE
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93720-2989
Country	:	US
Telephone Number	:	559-224-7990
Fax Number	:	559-224-5617

Provider Business Practice Location Address
First Line	:	568 E HERNDON AVE
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93720-2989
Country	:	US
Telephone Number	:	559-224-7990
Fax Number	:	559-224-5617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. NAGARATNAMMA MADIREDDY M.D.” Practice Location

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