MEDICARE: NAGAMMA DUDDEMPUDI PHYSICIAN PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1972747624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAGAMMA DUDDEMPUDI PHYSICIAN PC

Provider Business Mailing Address
First Line	:	1502 CATON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1006
Country	:	US
Telephone Number	:	718-693-3300
Fax Number	:	718-693-3378

Provider Business Practice Location Address
First Line	:	1502 CATON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1006
Country	:	US
Telephone Number	:	718-693-3300
Fax Number	:	718-693-3378

Authorized Official
Title or Position	:	OWNER
Name	:	NAGAMMA DUDDENPUDI
Credential	:	MD
Telephone Number	:	718-693-3300

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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