Individual
MRS. PADMAJA PAM POLAVARAPU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1810 59TH ST W, BRADENTON, FL 34209-4630
(941) 792-1412
(941) 795-0753
Mailing address
1810 59TH ST W, BRADENTON, FL 34209-4630
(941) 792-1412
(941) 795-0753
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME108341
FL
207R00000X
Internal Medicine Physician
17433
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006048641
—
VA
01
—
007822100
MEDICAID
WV
Enumeration date
08/30/2005
Last updated
03/13/2017
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