Provider Demographics
NPI:1649448911
Name:MUDDANA, NEEHARIKA (MD)
Entity type:Individual
Prefix:DR
First Name:NEEHARIKA
Middle Name:
Last Name:MUDDANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEEHARIKA
Other - Middle Name:
Other - Last Name:MUDDANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:418 GRAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4000
Mailing Address - Country:US
Mailing Address - Phone:304-865-5105
Mailing Address - Fax:304-865-5570
Practice Address - Street 1:418 GRAND PARK DR STE 311
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4000
Practice Address - Country:US
Practice Address - Phone:304-865-5105
Practice Address - Fax:304-865-5570
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090208207R00000X
WV25695207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027204Medicaid
WV9310001OtherGROUP PTAN
WVWV3874AMedicare UPIN