Healthcare Provider Details

I. General information

NPI: 1558525345
Provider Name (Legal Business Name): MURALIDHAR REDDY GUDDETI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 HOSPITAL RD STE 2300
INDIANA PA
15701-3699
US

IV. Provider business mailing address

640 KOLTER DR
INDIANA PA
15701-3570
US

V. Phone/Fax

Practice location:
  • Phone: 724-349-7820
  • Fax: 724-349-8816
Mailing address:
  • Phone: 724-357-7196
  • Fax: 724-357-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD445282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: