MEDICARE: NAGENDRA NADARAJA 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	208600000X	Surgery Physician	123182-1	NY

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

General Provider Information

NPI Number	:	1497747737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGENDRA NADARAJA M.D.

Provider Business Mailing Address
First Line	:	1561 LONG POND RD
Second Line	:	SUITE 107
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4117
Country	:	US
Telephone Number	:	585-723-7281
Fax Number	:	585-723-8660

Provider Business Practice Location Address
First Line	:	1561 LONG POND RD
Second Line	:	SUITE 107
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4117
Country	:	US
Telephone Number	:	585-723-7281
Fax Number	:	585-723-8660

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	11/07/2012

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