Provider Demographics
NPI:1316032907
Name:PANDURANGI, SETURAM (MD)
Entity Type:Individual
Prefix:
First Name:SETURAM
Middle Name:
Last Name:PANDURANGI
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 1:1620 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3551
Mailing Address - Country:US
Mailing Address - Phone:707-425-2002
Mailing Address - Fax:707-425-2011
Practice Address - Street 1:1620 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3551
Practice Address - Country:US
Practice Address - Phone:707-425-2002
Practice Address - Fax:707-425-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA313120207KA0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA313120Medicaid
CAA26433Medicare UPIN
CA00A313120Medicare ID - Type Unspecified