MEDICARE: PRAMEELA MADAMALA MD

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	M0159	TX

General Provider Information

NPI Number	:	1689646390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAMEELA MADAMALA MD

Provider Business Mailing Address
First Line	:	151 CALDERON AVE
Second Line	:	#144
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1463
Country	:	US
Telephone Number	:	650-969-2907
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 CALDERON AVE
Second Line	:	#144
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1463
Country	:	US
Telephone Number	:	650-969-2907
Fax Number	:

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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