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Organization

MALLIKARJUNA NANDYALA MD PA

Active
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Organization

MALLIKARJUNA NANDYALA MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MALLIKARJUNA NANDYALA M.D. (OWNER)
(813) 884-0222
Entity
Organization

Contact information

Practice address
8313 W HILLSBOROUGH AVE STE 300, TAMPA, FL 33615-3819
(813) 884-0222
(813) 884-0080
Mailing address
14749 WATERCHASE BLVD, TAMPA, FL 33626-3318
(813) 884-0222
(813) 884-0080

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0070271
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110244550
RAILROAD MEDICARE
FL
05
—
250560600
—
FL
01
—
ME0070271
MEDICAL STATE LICENSE
FL
Enumeration date
10/07/2009
Last updated
01/30/2013
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