Provider Demographics
NPI:1043261043
Name:NAIDU, SAKKUBAI (MD)
Entity type:Individual
Prefix:
First Name:SAKKUBAI
Middle Name:
Last Name:NAIDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205
Mailing Address - Country:US
Mailing Address - Phone:443-923-2778
Mailing Address - Fax:443-923-2779
Practice Address - Street 1:707 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:443-923-2778
Practice Address - Fax:443-923-2779
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD313882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD13833Medicare UPIN
MDMB65Medicare ID - Type UnspecifiedINDIVIDUAL
MDKR37JHMedicare ID - Type UnspecifiedINDIVIDUAL