Provider Demographics
NPI:1275199689
Name:MUDDANA, PRITHVI (MD)
Entity Type:Individual
Prefix:
First Name:PRITHVI
Middle Name:
Last Name:MUDDANA
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 1:11937 US HWY 271
Mailing Address - Street 2:ATTN: KATE WELLS
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708
Mailing Address - Country:US
Mailing Address - Phone:903-877-7000
Mailing Address - Fax:
Practice Address - Street 1:11937 US HWY 271
Practice Address - Street 2:ATTN: KATE WELLS
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708
Practice Address - Country:US
Practice Address - Phone:903-877-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1974207R00000X, 208M00000X
TXBP10068792390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program