Provider Demographics
NPI:1114102910
Name:GUNDAPPU REDDY, PRABHAKAR REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAKAR REDDY
Middle Name:
Last Name:GUNDAPPU REDDY
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 1:7241 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8958
Mailing Address - Country:US
Mailing Address - Phone:505-514-2779
Mailing Address - Fax:
Practice Address - Street 1:230 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9447
Practice Address - Country:US
Practice Address - Phone:570-420-1955
Practice Address - Fax:570-424-0707
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444083207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine