Individual
DR. MANGADHARA RAO MADINEEDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MSA, FACP
Contact information
Practice address
940 BELMONT ST, GERIATRICS & EXTENDED CARE SERVICE LINE (181), BROCKTON, MA 02301-5596
(774) 826-1860
(774) 826-2643
Mailing address
940 BELMONT ST, BROCKTON, MA 02301-5596
(508) 583-4500
(774) 826-3157
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
79686
MA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
79686
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3136809
—
MA
01
—
MM0137186AS
STATE CONTROLLED SUBSTANC
MA
Enumeration date
08/05/2006
Last updated
03/07/2023
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