MEDICARE: DR. PRIYA PRIYAMBADA 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	207Q00000X	Family Medicine Physician	30298	MS
2	207Q00000X	Family Medicine Physician	E-9492	AR
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	30298	MS
4	207Q00000X	Family Medicine Physician	2025-02436	NC

General Provider Information

NPI Number	:	1649535519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYA PRIYAMBADA M.D

Provider Business Mailing Address
First Line	:	3150 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-3880
Country	:	US
Telephone Number	:	336-716-7811
Fax Number	:	336-716-9526

Provider Business Practice Location Address
First Line	:	3150 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-3880
Country	:	US
Telephone Number	:	336-716-7811
Fax Number	:	336-716-9526

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	12/17/2025

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