Provider Demographics
NPI:1578770095
Name:POTU, SANGEETHA (MD)
Entity Type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:POTU
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 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-355-0720
Mailing Address - Fax:704-355-5948
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:CMC ANNEX 1ST FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-0720
Practice Address - Fax:704-355-5948
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084307207R00000X
FLME104915207R00000X, 207RN0300X
NC2010-01503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2385Medicaid
NC1578770095Medicaid
NCNC1409EMedicare PIN
SCNC2385Medicaid
NCNC1490CMedicare PIN
NCNC1409DMedicare PIN