Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 14742 | MD |
NPI | 1003126137 |
---|---|
Provider Name | Dr. Madhu Venkata Rama Raju Nadimpalli |
First Address | Ellicott City, MD 21043-3247 |
Second Address | District Heights, MD 20747-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2010 |
Last Update Date | 14/01/2015 |