Individual
VIDYASAGAR MOKUREDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JOHN ROEMMELT DR, HORSEHEADS, NY 14845-8301
(607) 795-2828
(607) 795-2829
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
225976
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019347550001
—
PA
05
—
02355668
—
NY
Enumeration date
11/22/2006
Last updated
06/16/2016
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