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General NPI Number Information
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NPI Number | 1699752881
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Entity Type | Individual
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Provider Name | VISWANADHAM POTHULA M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | PSC 475 BOX 1752
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City | FPO
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State | AP
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Zip | 96350
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Country | JP
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Telephone | 01181468165775
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 475 BOX 1752
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City | FPO
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State | AP
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Zip | 96350
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Country | JP
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 185852
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License Number State | NY
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