MEDICARE: ANANTHRAM POTTIPATI REDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	35064253	OH
2	207RG0100X	Gastroenterology Physician	17118	WV
3	207RG0100X	Gastroenterology Physician	MD044783L	PA
4	207RG0100X	Gastroenterology Physician	C 52423	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	GN258A	OTHER	CA	MEDICARE GROUP PTAN
4	GN609Z	OTHER	CA	MEDICARE PTAN
5	W21999	OTHER	CA	MEDICARE PTAN SDIGN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124014923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANANTHRAM POTTIPATI REDDY M.D.

Provider Business Mailing Address
First Line	:	9456 CUYAMACA ST
Second Line	:	SUITE 102
City	:	SANTEE
State	:	CA
Zip	:	92071-5915
Country	:	US
Telephone Number	:	619-588-4074
Fax Number	:	619-588-4004

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD STE 2301
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5241
Country	:	US
Telephone Number	:	619-588-4074
Fax Number	:	619-588-4004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	02/18/2025

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Directions to “ ANANTHRAM POTTIPATI REDDY M.D.” Practice Location

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