1306980792 NPI number — DR. SUNDARARAMIREDDY S PASEM MD

Table of content: DR. SUNDARARAMIREDDY S PASEM MD (NPI 1306980792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306980792 NPI number — DR. SUNDARARAMIREDDY S PASEM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASEM
Provider First Name:
SUNDARARAMIREDDY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PASEM
Provider Other First Name:
REDDY
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306980792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 S US 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMTERVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33585-5141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-793-5900
Provider Business Mailing Address Fax Number:
352-793-6269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 SW COLLEGE RD
Provider Second Line Business Practice Location Address:
SUITE#4
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-7406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-237-0550
Provider Business Practice Location Address Fax Number:
352-237-0749
Provider Enumeration Date:
02/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  31249 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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