Provider Demographics
NPI:1255624540
Name:SANGEETHA POTU,MD,PA
Entity type:Organization
Organization Name:SANGEETHA POTU,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-778-0161
Mailing Address - Street 1:14432 TRIBUTE PLACE DR
Mailing Address - Street 2:201
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 GAMBLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4439
Practice Address - Country:US
Practice Address - Phone:704-778-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01503207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty