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General NPI Number Information
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NPI Number | 1841689221
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Entity Type | Organization
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Legal Business Name | PAVAN PAMADURTHI M.D., P.A.
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3447 RENNER RD STE 120
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City | PLANO
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State | TX
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Zip | 75074-0051
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Country | US
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Telephone | 469-941-4546
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Fax | 469-941-4543
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Provider Business Mailing Address
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Address Line | 3447 RENNER RD STE 120
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City | PLANO
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State | TX
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Zip | 75074-0051
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Country | US
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Telephone | 469-941-4546
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Fax | 469-941-4543
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | PAVAN KUMAR REDDY PAMADURTHI
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Credential | M.D., P.A.
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Telephone | 469-941-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | P5865
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License Number State | TX
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