Provider Demographics
NPI:1063465573
Name:KODOTH, SANGEETHA (MD)
Entity Type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:KODOTH
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 1:1346 DOWELL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2453
Mailing Address - Country:US
Mailing Address - Phone:865-588-2753
Mailing Address - Fax:865-588-7418
Practice Address - Street 1:1346 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2453
Practice Address - Country:US
Practice Address - Phone:865-588-2753
Practice Address - Fax:865-588-7418
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35779207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3873642Medicaid
TNQ009338Medicaid