Provider Demographics
NPI:1447246699
Name:NARALA, MADHAVA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:MADHAVA
Middle Name:REDDY
Last Name:NARALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 E HERNDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-221-7500
Mailing Address - Fax:559-248-2472
Practice Address - Street 1:568 E HERNDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-221-7500
Practice Address - Fax:559-248-2472
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51494207RC0200X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514940Medicaid
CAA51494OtherSTATE LICENSE NUMBER
CAGR0077501Medicaid
CAGR0077501Medicaid
CAZZZ13693ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAGR0077501Medicaid