Basic Information
| Provider Information | |||||||||
| NPI: | 1770826174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NARAM | ||||||||
| FirstName: | ANURADHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLAZA | ||||||||
| Address2: | PHYSICIAN ENTERPRISE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182407143 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 LINDEN BOULEVARD | ||||||||
| Address2: | BRISTOL FAMILY CARE CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405071 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 05/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C1-0010547 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.