Basic Information
| Provider Information | |||||||||
| NPI: | 1386180677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN MEDICAL GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CLOCK TOWER CMNS | ||||||||
| Address2: | |||||||||
| City: | BREWSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105094055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452795187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 159 BARNEGAT RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126015402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454713500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2017 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHOUDRY | ||||||||
| AuthorizedOfficialFirstName: | MADDIPOTI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8452795187 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.