Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 246088 | NY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 246088 | NY |
NPI | 1174710503 |
---|---|
Provider Name | Padmaja Madala |
First Address | Albany, NY 12207-1300 |
Second Address | Albany, NY 12207-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 18/11/2020 |