Provider Demographics
NPI:1447633201
Name:KANMANTHAREDDY, AVANIJA (MD)
Entity type:Individual
Prefix:
First Name:AVANIJA
Middle Name:
Last Name:KANMANTHAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AVANIJA
Other - Middle Name:
Other - Last Name:BUDDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:2690 SOUTHFIELD DR STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4510
Mailing Address - Country:US
Mailing Address - Phone:717-741-1414
Mailing Address - Fax:
Practice Address - Street 1:2690 SOUTHFIELD DR STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4510
Practice Address - Country:US
Practice Address - Phone:717-741-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7496207R00000X
NE31026207RG0100X
PAMD484938207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine