Provider Demographics
NPI:1134428220
Name:ADDAGANTI VENKATA, SATYA NAGARAJU (MS)
Entity type:Individual
Prefix:
First Name:SATYA NAGARAJU
Middle Name:
Last Name:ADDAGANTI VENKATA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WYE OAK DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1929
Mailing Address - Country:US
Mailing Address - Phone:410-200-5850
Mailing Address - Fax:
Practice Address - Street 1:34205 OLD OCEAN CITY RD UNIT E
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21850-2083
Practice Address - Country:US
Practice Address - Phone:410-835-8585
Practice Address - Fax:410-835-8686
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004072183500000X
MD18917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist