Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MT209864 | PA |
Y | 111NI0900X | Internist | MT209864 | PA |
NPI | 1003298241 |
---|---|
Provider Name | Swathi Maddula |
First Address | Philadelphia, PA 19102-1101 |
Second Address | Philadelphia, PA 19102-1101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 24/06/2015 |