MEDICARE: DR. KRISHNA KUMAR VADLAMUDI 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	111069	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	:	1649279472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISHNA KUMAR VADLAMUDI M.D.

Provider Business Mailing Address
First Line	:	45 1ST ST
Second Line	:
City	:	ILION
State	:	NY
Zip	:	13357-1710
Country	:	US
Telephone Number	:	315-895-7408
Fax Number	:	315-894-2072

Provider Business Practice Location Address
First Line	:	45 1ST ST
Second Line	:
City	:	ILION
State	:	NY
Zip	:	13357-1710
Country	:	US
Telephone Number	:	315-895-7408
Fax Number	:	315-894-2072

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/08/2007

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