Provider Demographics
NPI:1306894795
Name:KATRAGADDA, SITHARAMA SWAMY (MD)
Entity type:Individual
Prefix:
First Name:SITHARAMA
Middle Name:SWAMY
Last Name:KATRAGADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1246
Mailing Address - Country:US
Mailing Address - Phone:304-363-0872
Mailing Address - Fax:
Practice Address - Street 1:13 PHEASANT DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-363-1830
Practice Address - Fax:304-363-0404
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13325207L00000X
PAMD430917207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55069991000OtherWEST VIRGINIA COMPENSATIO
WV13325OtherTHE HEALTH PLAN
45344OtherCLARE LINE COVENTRY H AS
B95280Medicare UPIN
45344OtherCLARE LINE COVENTRY H AS