Provider Demographics
NPI:1184037822
Name:PRODDUTUR, SANKETH
Entity Type:Individual
Prefix:
First Name:SANKETH
Middle Name:
Last Name:PRODDUTUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTGATE AVE STE 101
Mailing Address - Street 2:UPMC ST MARGARET HOSPITAL
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 EASTGATE AVE STE 101
Practice Address - Street 2:UPMC ST MARGARET HOSPITAL
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1392
Practice Address - Country:US
Practice Address - Phone:724-684-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461835207Q00000X
PAMT207145390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program