Basic Information
Provider Information | |||||||||
NPI: | 1922414440 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SINGIREDDY | ||||||||
FirstName: | SAMPATH | ||||||||
MiddleName: | REDDY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2895 | ||||||||
Address2: |   | ||||||||
City: | CULLMAN | ||||||||
State: | AL | ||||||||
PostalCode: | 350562895 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2567355072 | ||||||||
FaxNumber: | 2568017626 | ||||||||
Practice Location | |||||||||
Address1: | 1912 AL HIGHWAY 157 | ||||||||
Address2: |   | ||||||||
City: | CULLMAN | ||||||||
State: | AL | ||||||||
PostalCode: | 350580609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2567372095 | ||||||||
FaxNumber: | 2567372097 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2014 | ||||||||
LastUpdateDate: | 09/23/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/23/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 42698 | AL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0000X | MD.42698 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 271453 | 05 | AL |   | MEDICAID |