Provider Demographics
NPI:1700016235
Name:VANGALA, SEETA RAM REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SEETA RAM
Middle Name:REDDY
Last Name:VANGALA
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 1:7301 MARQUIS LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3486
Mailing Address - Country:US
Mailing Address - Phone:860-805-3133
Mailing Address - Fax:
Practice Address - Street 1:26875 US HIGHWAY 380 E STE 128
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-4807
Practice Address - Country:US
Practice Address - Phone:469-312-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9011208000000X
OK35033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX462261501Medicaid