Provider Demographics
NPI:1497856561
Name:KURRI YERRAM, SUJANA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJANA
Middle Name:REDDY
Last Name:KURRI YERRAM
Suffix:
Gender:F
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-1324
Mailing Address - Fax:610-327-4432
Practice Address - Street 1:305 SECOND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2658
Practice Address - Country:US
Practice Address - Phone:484-961-8220
Practice Address - Fax:610-327-4432
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4322592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020343050002Medicaid
PA232359401OtherMLHC TIN
PA1020343050002Medicaid
PA232359401OtherMLHC TIN