Provider Demographics
NPI:1053426163
Name:MADDELA, RICARDO BARRIOS (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:BARRIOS
Last Name:MADDELA
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:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419
Mailing Address - Country:US
Mailing Address - Phone:270-826-9595
Mailing Address - Fax:270-826-3656
Practice Address - Street 1:1413 N ELM ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-826-9595
Practice Address - Fax:270-826-3656
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19313208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64193139Medicaid
KY1068701Medicare ID - Type Unspecified
KY64193139Medicaid