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General NPI Number Information
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NPI Number | 1700016235
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Entity Type | Individual
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Provider Name | SEETA RAM REDDY VANGALA MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 26875 US HIGHWAY 380 E STE 128
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City | AUBREY
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State | TX
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Zip | 76227-4807
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Country | US
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Telephone | 469-312-1451
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 MARQUIS LN
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City | IRVING
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State | TX
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Zip | 75063-3486
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Country | US
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Telephone | 860-805-3133
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R9011
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35033
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License Number State | OK
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