Basic Information
| Provider Information | |||||||||
| NPI: | 1164464590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NARRA | ||||||||
| FirstName: | MADHU | ||||||||
| MiddleName: | BABU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2851 S AVENUE B STE 2001 | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283362434 | ||||||||
| FaxNumber: | 9283362435 | ||||||||
| Practice Location | |||||||||
| Address1: | 2851 S AVENUE B STE 2001 | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283362434 | ||||||||
| FaxNumber: | 9283362435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | N5277 | TX | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | 52456 | AZ | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 343795YQ3Y | 01 | TX | MEDICARE PTAN | OTHER |