Provider Demographics
NPI:1861439341
Name:VANKIREDDY, HARITHA (MD)
Entity Type:Individual
Prefix:
First Name:HARITHA
Middle Name:
Last Name:VANKIREDDY
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 1:3901 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4918
Mailing Address - Country:US
Mailing Address - Phone:425-397-1704
Mailing Address - Fax:425-335-5145
Practice Address - Street 1:8910 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2400
Practice Address - Country:US
Practice Address - Phone:425-397-1704
Practice Address - Fax:425-335-5145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040573207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8360448Medicaid
WA8876430Medicare PIN
WA8360448Medicaid
WAGAB39356Medicare ID - Type Unspecified