Provider Demographics
NPI:1073530549
Name:PARVATHAREDDY, VISHNUPRIYADEVI (MD)
Entity Type:Individual
Prefix:
First Name:VISHNUPRIYADEVI
Middle Name:
Last Name:PARVATHAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 W MIDAS POINT CV
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-2118
Mailing Address - Country:US
Mailing Address - Phone:701-388-3576
Mailing Address - Fax:
Practice Address - Street 1:INTERMOUNTAIN MEDICAL CENTER
Practice Address - Street 2:5121 COTTONWOOD ST
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-507-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9872207R00000X
UT11353382-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I23223Medicare UPIN