Provider Demographics
NPI:1114222155
Name:SUMANA & ANANTHRAM REDDY MD INC
Entity Type:Organization
Organization Name:SUMANA & ANANTHRAM REDDY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-875-2865
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:SUITE 2301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5238
Mailing Address - Country:US
Mailing Address - Phone:619-588-4074
Mailing Address - Fax:619-588-4004
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:SUITE 2301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5238
Practice Address - Country:US
Practice Address - Phone:619-588-4074
Practice Address - Fax:619-588-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52581207K00000X
CAC52423207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52423OtherANANTHRAM REDDY, MD LICENSE
1124014923OtherANANTHRAM REDDY, MD NPI
1053300251OtherSUMANA REDDY, MD NPI
CAC52581OtherSUMANA REDDY, MD LICENSE
OHF44002Medicare UPIN