MEDICARE: NAGAMMA DUDDEMPUDI 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	143382	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	:	1609869585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGAMMA DUDDEMPUDI M.D.

Provider Business Mailing Address
First Line	:	12 BASS POND DR
Second Line	:
City	:	OLD WESTBURY
State	:	NY
Zip	:	11568-1307
Country	:	US
Telephone Number	:	516-626-6519
Fax Number	:	516-626-6520

Provider Business Practice Location Address
First Line	:	1502 CATON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1006
Country	:	US
Telephone Number	:	718-693-3300
Fax Number	:	718-693-3378

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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