Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA08199100 | NJ |
N | 111NI0900X | Internist | 25MA08199100 | NJ |
Y | 207R00000X | Internist | MD430557 | PA |
Y | 111NI0900X | Internist | MD430557 | PA |
N | 207RG0300X | Geriatric Medicine | 25MA08199100 | NJ |
N | 207RG0300X | Geriatric Medicine | MD430557 | PA |
N | 207RH0002X | Hospice and Palliative Medicine | 25MA08199100 | NJ |
N | 207RH0002X | Hospice and Palliative Medicine | MD430557 | PA |
NPI | 1013043520 |
---|---|
Provider Name | Sivakoti Nagireddy Guda |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 23/03/2017 |