Provider Demographics
NPI:1528139060
Name:PALADUGU, MYTHILI (MD)
Entity type:Individual
Prefix:
First Name:MYTHILI
Middle Name:
Last Name:PALADUGU
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:PO BOX 33434
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-3434
Mailing Address - Country:US
Mailing Address - Phone:817-332-8346
Mailing Address - Fax:817-332-1723
Practice Address - Street 1:851 W TERRELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3161
Practice Address - Country:US
Practice Address - Phone:817-332-8346
Practice Address - Fax:817-332-1723
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6326202K00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197922103Medicaid
TX281725YRE1Medicare PIN