Provider Demographics
NPI:1528144995
Name:DASARI, PADMA (MD)
Entity type:Individual
Prefix:
First Name:PADMA
Middle Name:
Last Name:DASARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PADMAVATHI
Other - Middle Name:S
Other - Last Name:DASARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1006 MARY BETH TER
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3182
Mailing Address - Country:US
Mailing Address - Phone:617-290-4415
Mailing Address - Fax:
Practice Address - Street 1:2333 MOWRY AVE # CA94538
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1625
Practice Address - Country:US
Practice Address - Phone:510-796-0222
Practice Address - Fax:510-796-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80224207R00000X
CAC191135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA699999OtherPILGRIM
MA110055984AOtherMASS HEALTH
MADAA20200OtherBLUE CROSS BLUE SHIELD
MA3140466Medicaid
MA791424OtherTUFTS
MA110055984AOtherMASS HEALTH
MA699999OtherPILGRIM