Provider Demographics
NPI:1982835112
Name:PAMADURTHI, PAVAN KUMAR REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PAVAN
Middle Name:KUMAR REDDY
Last Name:PAMADURTHI
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 1:3447 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
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP58652084P0800X
MS754L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293768YSYFMedicare PIN