Provider Demographics
NPI:1033615455
Name:REDDY, ABHINAY BODDU (DO)
Entity Type:Individual
Prefix:DR
First Name:ABHINAY
Middle Name:BODDU
Last Name:REDDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MT. ST. MARY'S HOSPITAL
Mailing Address - Street 2:5300 MILITARY ROAD
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092
Mailing Address - Country:US
Mailing Address - Phone:716-297-4800
Mailing Address - Fax:
Practice Address - Street 1:MT. ST. MARY'S HOSPITAL
Practice Address - Street 2:5300 MILITARY DRIVE
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092
Practice Address - Country:US
Practice Address - Phone:716-297-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine