Provider Demographics
NPI:1124014923
Name:REDDY, ANANTHRAM POTTIPATI (MD)
Entity Type:Individual
Prefix:
First Name:ANANTHRAM
Middle Name:POTTIPATI
Last Name:REDDY
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 1:9456 CUYAMACA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5915
Mailing Address - Country:US
Mailing Address - Phone:619-588-4074
Mailing Address - Fax:619-588-4004
Practice Address - Street 1:6699 ALVARADO RD STE 2301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5241
Practice Address - Country:US
Practice Address - Phone:619-229-1005
Practice Address - Fax:619-588-4004
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064253207RG0100X
WV17118207RG0100X
PAMD044783L207RG0100X
CAC 52423207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN258AOtherMEDICARE GROUP PTAN
OH0858620Medicaid
CAGN609ZOtherMEDICARE PTAN
WV3004393000Medicaid
CAW21999OtherMEDICARE PTAN SDIGN
OHE50310Medicare UPIN
OH0858620Medicaid