MEDICARE: DR. BINA ADIGOPULA 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	208000000X	Pediatrics Physician	A45273	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A45273	OTHER	CA	MEDICAL BOARD LICENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982686200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BINA ADIGOPULA M.D.

Provider Business Mailing Address
First Line	:	6942 UNIVERSITY AVE
Second Line	:	#A
City	:	LA MESA
State	:	CA
Zip	:	91942-5963
Country	:	US
Telephone Number	:	619-698-2184
Fax Number	:	619-698-2084

Provider Business Practice Location Address
First Line	:	6942 UNIVERSITY AVE
Second Line	:	#A
City	:	LA MESA
State	:	CA
Zip	:	91942-5963
Country	:	US
Telephone Number	:	619-698-2184
Fax Number	:	619-698-2084

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/15/2011

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