Provider Demographics
NPI:1104434307
Name:PEDDAPANGA, CHRISTINE S (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:PEDDAPANGA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5392
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5392
Mailing Address - Country:US
Mailing Address - Phone:601-703-9407
Mailing Address - Fax:601-703-9283
Practice Address - Street 1:321 HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MS
Practice Address - Zip Code:39117-3353
Practice Address - Country:US
Practice Address - Phone:601-732-8612
Practice Address - Fax:601-732-1957
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK0377R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine