Provider Demographics
NPI:1912013954
Name:LATHA, SWARNA ERRAMREDDI (MD)
Entity Type:Individual
Prefix:
First Name:SWARNA
Middle Name:ERRAMREDDI
Last Name:LATHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1852 N MASTICK WAY
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1063
Mailing Address - Country:US
Mailing Address - Phone:520-761-2128
Mailing Address - Fax:520-281-1112
Practice Address - Street 1:675 WATER ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3063
Practice Address - Country:US
Practice Address - Phone:952-474-4167
Practice Address - Fax:952-474-5700
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN36343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100537OtherUCARE
MN566K6LAOtherHEALTHPARTNERS
MN58784OtherARAZ
MN566K61AOtherBLUE CROSS
MNO85231700Medicaid
MN012552OtherMEDICA
MN566K6LAOtherHEALTHPARTNERS
MNF68379Medicare UPIN