Healthcare Provider Details

I. General information

NPI: 1578946455
Provider Name (Legal Business Name): RAMYA SUDHA GORTHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13634 N 93RD AVE STE 100
PEORIA AZ
85381-4915
US

IV. Provider business mailing address

13634 N 93RD AVE STE 100
PEORIA AZ
85381-4915
US

V. Phone/Fax

Practice location:
  • Phone: 623-933-0301
  • Fax: 623-933-0224
Mailing address:
  • Phone: 623-933-0301
  • Fax: 623-933-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80565
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number80565
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: