Provider Demographics
NPI:1154552891
Name:SIDDINENI, RAJITHA (MD)
Entity type:Individual
Prefix:
First Name:RAJITHA
Middle Name:
Last Name:SIDDINENI
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 1:532 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2458
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-737-1643
Practice Address - Street 1:532 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2458
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-737-1643
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1310097Medicaid
MAMS0891300AOtherCONTROLLED SUBSTANCE REGISTRATION
MAMS0891300AOtherCONTROLLED SUBSTANCE REGISTRATION
MAMS0891300AOtherCONTROLLED SUBSTANCE REGISTRATION
MA221823Medicare Oscar/Certification