MEDICARE: DR. INDUKALA DODDAMANE MBBS

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	207U00000X	Nuclear Medicine Physician	043712	CT
2	207U00000X	Nuclear Medicine Physician	230974-01	NY

General Provider Information

NPI Number	:	1780667113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDUKALA DODDAMANE MBBS

Provider Business Mailing Address
First Line	:	415 GUNNAR CT
Second Line	:
City	:	CHESHIRE
State	:	CT
Zip	:	06410-1991
Country	:	US
Telephone Number	:	203-439-2041
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	718-918-3044
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	10/09/2019

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