Provider Demographics
NPI:1043403421
Name:JAIVEER T. REDDY, M.D.
Entity Type:Organization
Organization Name:JAIVEER T. REDDY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIVEER
Authorized Official - Middle Name:T
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-849-8858
Mailing Address - Street 1:82 BARNETT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1262
Mailing Address - Country:US
Mailing Address - Phone:814-849-8858
Mailing Address - Fax:814-849-3471
Practice Address - Street 1:82 BARNETT ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1262
Practice Address - Country:US
Practice Address - Phone:814-849-8858
Practice Address - Fax:814-849-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004255427OtherAETNA
PA000647986OtherION
PA1035599OtherGATEWAY
PA104041OtherHIGHMARK
PA0006479680001Medicaid
PA1043403421OtherTRAVELERS MEDICARE
PA1043403421OtherUMWA
PA89212OtherUNISON
PA000000089212OtherTHREE RIVERS
PA217070OtherUPMC
PA0006479680001Medicaid
PA1035599OtherGATEWAY