Provider Demographics
NPI:1942468152
Name:SIDDABATTULA, RATNAKANTH MOHANRAO (MD)
Entity Type:Individual
Prefix:
First Name:RATNAKANTH
Middle Name:MOHANRAO
Last Name:SIDDABATTULA
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 1:13504 ATTLEBORO CT
Mailing Address - Street 2:APT # 21
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1557
Mailing Address - Country:US
Mailing Address - Phone:917-622-5441
Mailing Address - Fax:
Practice Address - Street 1:16 E HANOVER ST APT 21
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7752
Practice Address - Country:US
Practice Address - Phone:717-420-2631
Practice Address - Fax:717-420-2885
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAP22784397762207R00000X
PAMD469384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine