Healthcare Provider Details

I. General information

NPI: 1891984910
Provider Name (Legal Business Name): SANTI KOMMAREDDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOSPITAL DR STE 370
ATHENS OH
45701-2857
US

IV. Provider business mailing address

90 E 2ND ST
CHILLICOTHEE OH
45601-2523
US

V. Phone/Fax

Practice location:
  • Phone: 740-566-4530
  • Fax:
Mailing address:
  • Phone: 740-779-1053
  • Fax: 740-773-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35-044632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: