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Individual

MAMATHA KADIYALA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3271
(508) 856-5911
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
223247
MA
207L00000X
Anesthesiology Physician
97285
GA
207L00000X
Anesthesiology Physician
U2239
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110041533A
MA
Enumeration date
11/02/2005
Last updated
12/14/2023
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