Provider Demographics
NPI:1427082171
Name:VATTAM, SREENADHA REDDY (MD)
Entity type:Individual
Prefix:
First Name:SREENADHA
Middle Name:REDDY
Last Name:VATTAM
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 1:1001 SARA SWAMY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3124
Mailing Address - Country:US
Mailing Address - Phone:903-892-1999
Mailing Address - Fax:903-892-6999
Practice Address - Street 1:1001 SARA SWAMY DR STE 220
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3124
Practice Address - Country:US
Practice Address - Phone:903-892-1999
Practice Address - Fax:903-892-6999
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM28512081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I37401Medicare UPIN
CT25000359Medicare ID - Type Unspecified