MEDICARE: DR. SAMANTHA SANTHI MADALA 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	207W00000X	Ophthalmology Physician	A188534	CA

General Provider Information

NPI Number	:	1972243459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA SANTHI MADALA MD

Provider Business Mailing Address
First Line	:	1200 N STATE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-1001
Country	:	US
Telephone Number	:	408-656-3891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N STATE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-1001
Country	:	US
Telephone Number	:	323-226-2622
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	04/06/2026

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