Provider Demographics
NPI:1245124809
Name:POTHAPRAGADA, SAI SRI RAKSHA (MD)
Entity type:Individual
Prefix:
First Name:SAI SRI RAKSHA
Middle Name:
Last Name:POTHAPRAGADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAKSHA
Other - Middle Name:
Other - Last Name:POTHAPRAGADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 BUTTONWOOD STREET
Mailing Address - Street 2:APT 1208
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:571-425-6996
Mailing Address - Fax:
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:800-836-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT234139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty