Provider Demographics
NPI:1093813784
Name:REDDY CARDIOVASCULAR ASSOCIATES PC
Entity Type:Organization
Organization Name:REDDY CARDIOVASCULAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VARDHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-266-3240
Mailing Address - Street 1:504 GREENBRIER CT
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3335
Mailing Address - Country:US
Mailing Address - Phone:740-266-3240
Mailing Address - Fax:
Practice Address - Street 1:3150 JOHNSON RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2307
Practice Address - Country:US
Practice Address - Phone:740-266-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDDY CARDIOVASCULAR ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079717246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2670471Medicaid
WV3810002528Medicaid
OH2670471Medicaid
WVID02931Medicare PIN
WV3810002528Medicaid