Provider Demographics
NPI:1588246300
Name:RAJAMREDDY, SARPITHA (DNB)
Entity type:Individual
Prefix:
First Name:SARPITHA
Middle Name:
Last Name:RAJAMREDDY
Suffix:
Gender:F
Credentials:DNB
Other - Prefix:
Other - First Name:SARPITHA
Other - Middle Name:
Other - Last Name:R
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNB
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-7243
Mailing Address - Fax:336-716-7432
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-7243
Practice Address - Fax:336-716-7432
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2022-013652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program