Healthcare Provider Details

I. General information

NPI: 1952798910
Provider Name (Legal Business Name): SRIHARSHA GUMMADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE MOB SOUTH SUITE 422
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE MOB SOUTH SUITE 422
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-2169
  • Fax:
Mailing address:
  • Phone: 484-476-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD461912
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: