Provider Demographics
NPI:1164488250
Name:KONDAVEETI, KOTAYYA E (MD)
Entity type:Individual
Prefix:
First Name:KOTAYYA
Middle Name:E
Last Name:KONDAVEETI
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 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 453
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-621-0220
Mailing Address - Fax:412-621-5486
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 453
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-621-0220
Practice Address - Fax:412-621-5486
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026112E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101647OtherUPMC
PA0009150940001Medicaid
PA3058OtherHA
PA428525LFHMedicare ID - Type Unspecified
PA0009150940001Medicaid