Provider Demographics
NPI:1942483284
Name:VEMURI-REDDY, SIREESHA MATTA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIREESHA
Middle Name:MATTA
Last Name:VEMURI-REDDY
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:35 SOUTH MOUNTAIN BLVD.
Practice Address - Street 2:
Practice Address - City:MOUNTAINTOP
Practice Address - State:PA
Practice Address - Zip Code:18707-3832
Practice Address - Country:US
Practice Address - Phone:570-474-5978
Practice Address - Fax:570-474-5485
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1942483284OtherNPI
PA1030168940002Medicaid