Provider Demographics
NPI:1265798474
Name:BHUMIREDDY, GEETHA P (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:P
Last Name:BHUMIREDDY
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 1:21 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4318
Mailing Address - Country:US
Mailing Address - Phone:860-595-3130
Mailing Address - Fax:860-595-3129
Practice Address - Street 1:21 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4318
Practice Address - Country:US
Practice Address - Phone:860-595-3130
Practice Address - Fax:860-595-3129
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52095207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400088679Medicare PIN