Provider Demographics
NPI:1275516577
Name:KATTEGUMMULA, RANGA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RANGA
Middle Name:REDDY
Last Name:KATTEGUMMULA
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 1:8806 N NAVARRO ST STE 600
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1564
Mailing Address - Country:US
Mailing Address - Phone:361-485-2695
Mailing Address - Fax:361-485-0635
Practice Address - Street 1:1259 FM 1463 RD STE 500
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5480
Practice Address - Country:US
Practice Address - Phone:713-429-4550
Practice Address - Fax:832-397-6426
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115821403Medicaid
B23858Medicare UPIN
TXOOR41VMedicare ID - Type Unspecified