Provider Demographics
NPI:1295764355
Name:AMBATI, MEHAR SRIVANI REDDY (MD)
Entity type:Individual
Prefix:
First Name:MEHAR SRIVANI
Middle Name:REDDY
Last Name:AMBATI
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:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2810
Mailing Address - Country:US
Mailing Address - Phone:919-363-6060
Mailing Address - Fax:919-363-6040
Practice Address - Street 1:1071 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4268
Practice Address - Country:US
Practice Address - Phone:919-363-6060
Practice Address - Fax:919-363-6040
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00301271OtherPALMETTO GOVT SERV PROV#
NCFH2967220OtherFIRSTCAROLINACARE
NC5902911Medicaid
NC207646OtherMEDCOST
NC141JMOtherBCBS
NC2050658BMedicare PIN
NC5902911Medicaid