Individual
GANGADHAR MADUPU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1617 N JAMES ST, ROME, NY 13440-2852
(315) 533-1025
(315) 533-1006
Mailing address
1617 N JAMES ST, ROME, NY 13440-2852
(315) 533-1025
(315) 533-1006
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
216519
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02112967
—
NY
01
—
10049766
CDPHP
—
01
—
13625
MVP
NY
01
—
3099103
GHI
—
Enumeration date
10/13/2006
Last updated
07/08/2007
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