Provider Demographics
NPI:1871535179
Name:DODDAPANENI, BABURAO (MD)
Entity type:Individual
Prefix:DR
First Name:BABURAO
Middle Name:
Last Name:DODDAPANENI
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 1:4 UNADILLA PL
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-3010
Mailing Address - Country:US
Mailing Address - Phone:718-499-4995
Mailing Address - Fax:
Practice Address - Street 1:668 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6305
Practice Address - Country:US
Practice Address - Phone:718-499-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46D772Medicare ID - Type UnspecifiedPERSONAL PROVIDER #
NYA53838Medicare UPIN
NYW34161Medicare ID - Type UnspecifiedGROUP #