Provider Demographics
NPI:1134127624
Name:REDDY, GURIJALA N (MD)
Entity Type:Individual
Prefix:
First Name:GURIJALA
Middle Name:N
Last Name: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 1:6 FIELDCREST AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5645
Mailing Address - Country:US
Mailing Address - Phone:304-281-7928
Mailing Address - Fax:
Practice Address - Street 1:6 FIELDCREST AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5645
Practice Address - Country:US
Practice Address - Phone:304-281-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350457192085R0203X
WV122172085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0571411Medicaid
WV0123585000Medicaid
WV0123585000Medicaid
WVWV4661AMedicare PIN
OHH421751Medicare PIN