Provider Demographics
NPI:1093163719
Name:MADIREDDY, VARUN (MD)
Entity Type:Individual
Prefix:
First Name:VARUN
Middle Name:
Last Name:MADIREDDY
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 1:67-40 BOOTH STREET # L4
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5064
Mailing Address - Country:US
Mailing Address - Phone:917-842-3061
Mailing Address - Fax:
Practice Address - Street 1:115 1/2 REMSEN ST STE 500
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4212
Practice Address - Country:US
Practice Address - Phone:718-852-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299985207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty