Provider Demographics
NPI:1730473273
Name:POTHI REDDY, SEETHARAM REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SEETHARAM REDDY
Middle Name:
Last Name:POTHI REDDY
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 1:9605 SANDIFUR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-547-0827
Practice Address - Street 1:888 SWIFT BLVD.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-946-4611
Practice Address - Fax:509-942-2185
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60232882207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA025904OtherL&I KRMC GROUP NUMBER
WA1730473273Medicaid