Provider Demographics
NPI:1417254756
Name:R. KATTEGUMMULA, M.D, P.A.
Entity Type:Organization
Organization Name:R. KATTEGUMMULA, M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANGA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KATTEGUMMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-1652
Mailing Address - Street 1:215 OAK DR S STE K
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5618
Mailing Address - Country:US
Mailing Address - Phone:979-297-1652
Mailing Address - Fax:979-297-6322
Practice Address - Street 1:215 OAK DR S STE K
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5618
Practice Address - Country:US
Practice Address - Phone:979-297-1652
Practice Address - Fax:979-297-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000R41V2Medicaid
TXB23858Medicare UPIN