Individual
SATYANARAYANA M MAMIDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 CLARK ST UNIT 7, CAMBRIDGE, OH 43725-8875
(740) 439-5107
(740) 439-5183
Mailing address
1300 CLARK ST UNIT 7, CAMBRIDGE, OH 43725-8875
(740) 439-5107
(740) 439-5183
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
12853
WV
207RC0000X
Cardiovascular Disease Physician
Primary
35-045590
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001705987
MOUNTAINSTATE BLUECROSS B
—
05
—
0517435
—
OH
01
—
11-3703997
TAX ID
—
01
—
113703997 0004
CIGNA HEALTHCARE
—
01
—
DA3951
RAILROAD MEDICARE
—
Enumeration date
07/12/2006
Last updated
01/07/2011
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