Healthcare Provider Details

I. General information

NPI: 1134428220
Provider Name (Legal Business Name): SATYA NAGARAJU ADDAGANTI VENKATA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34205 OLD OCEAN CITY RD UNIT E
PITTSVILLE MD
21850-2083
US

IV. Provider business mailing address

725 WYE OAK DR
FRUITLAND MD
21826-1929
US

V. Phone/Fax

Practice location:
  • Phone: 410-835-8585
  • Fax: 410-835-8686
Mailing address:
  • Phone: 410-200-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004072
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18917
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: