MAMATHA P K MOODALAGIRIAIAH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

ACTIVE

Business

Title

First Name

MAMATHA

Middle

P K

Last Name

MOODALAGIRIAIAH

Business Name

MAMATHA P K MOODALAGIRIAIAH MD

Original Issue Date

06/17/2013

Effective Date

06/07/2023

Expiration Date

07/31/2026

City

NAPERVILLE

State

Zip

60540

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2023