Provider Demographics
NPI:1053393843
Name:MURTHY, SANGEETHA POTTY (MD)
Entity type:Individual
Prefix:DR
First Name:SANGEETHA
Middle Name:POTTY
Last Name:MURTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANGEETHA
Other - Middle Name:HARIHARAN
Other - Last Name:POTTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:2020 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4219
Mailing Address - Country:US
Mailing Address - Phone:858-499-2710
Mailing Address - Fax:
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE 287
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1619
Practice Address - Country:US
Practice Address - Phone:858-874-8741
Practice Address - Fax:888-420-4642
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A849500Medicaid
CAA84950OtherLICENSE
H10544Medicare UPIN
CAA84950Medicare PIN