Provider Demographics
NPI:1144485467
Name:VOOTLA, VAMSHIDHAR REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:VAMSHIDHAR
Middle Name:REDDY
Last Name:VOOTLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD STE 242
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6728
Mailing Address - Country:US
Mailing Address - Phone:240-513-7072
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 242
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6728
Practice Address - Country:US
Practice Address - Phone:240-513-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004077207R00000X
390200000X
MDD813701207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program