Provider Demographics
NPI:1801883640
Name:SEDDABATTULA, RAMVINAY S (MD)
Entity type:Individual
Prefix:
First Name:RAMVINAY
Middle Name:S
Last Name:SEDDABATTULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20610
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0610
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-296-7643
Practice Address - Street 1:1600 W CHANDLER BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6153
Practice Address - Country:US
Practice Address - Phone:480-907-6337
Practice Address - Fax:480-621-8107
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34297207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ953499Medicaid
AZ953499Medicaid
I42134Medicare UPIN