Healthcare Provider Details

I. General information

NPI: 1528905585
Provider Name (Legal Business Name): SIDDHANTH KUMAR MEKALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 RIDGE AVENUE GRADUATE MEDICAL EDUCATION, ROXBOROUG
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

5800 RIDGE AVENUE GRADUATE MEDICAL EDUCATION, ROXBOROUG
PHILADELPHIA PA
19128
US

V. Phone/Fax

Practice location:
  • Phone: 828-989-4003
  • Fax:
Mailing address:
  • Phone: 828-989-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: