Provider Demographics
NPI:1841689221
Name:PAVAN PAMADURTHI M.D., P.A.
Entity type:Organization
Organization Name:PAVAN PAMADURTHI M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:PAVAN
Authorized Official - Middle Name:KUMAR REDDY
Authorized Official - Last Name:PAMADURTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:469-941-4546
Mailing Address - Street 1:3447 RENNER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0051
Mailing Address - Country:US
Mailing Address - Phone:469-941-4546
Mailing Address - Fax:469-941-4543
Practice Address - Street 1:3447 RENNER RD STE 120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-0051
Practice Address - Country:US
Practice Address - Phone:469-941-4546
Practice Address - Fax:469-941-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP58652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty