Provider Demographics
NPI:1730342247
Name:MADDIRALA, SUNIL DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:DAVID
Last Name:MADDIRALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4936 VILLAGE CREST DRIVE
Mailing Address - Street 2:#207
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-245-7042
Mailing Address - Fax:
Practice Address - Street 1:4075 COPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7059
Practice Address - Country:US
Practice Address - Phone:888-632-0544
Practice Address - Fax:231-932-4105
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics