Provider Demographics
NPI:1427225317
Name:THATIGOTLA, BALA GANGADHARA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:BALA GANGADHARA
Middle Name:REDDY
Last Name:THATIGOTLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4401 DOMINION CREST DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-6257
Mailing Address - Country:US
Mailing Address - Phone:646-938-3785
Mailing Address - Fax:
Practice Address - Street 1:210 ASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6676
Practice Address - Country:US
Practice Address - Phone:919-350-7331
Practice Address - Fax:919-851-6757
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2022-03263208600000X
NY267683208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery