Provider Demographics
NPI:1154327781
Name:REDDY, PONNAVOLU D (MD)
Entity Type:Individual
Prefix:
First Name:PONNAVOLU
Middle Name:D
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 1:5115 US HIGHWAY 27 N STE 100
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1323
Mailing Address - Country:US
Mailing Address - Phone:863-385-2222
Mailing Address - Fax:863-382-8765
Practice Address - Street 1:5115 US HIGHWAY 27 N STE 100
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1323
Practice Address - Country:US
Practice Address - Phone:863-385-2222
Practice Address - Fax:863-382-8765
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85679207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51459OtherBCBS OF FL
285029OtherAVMED
P00282100OtherRAILROAD MEDICARE
285029OtherAVMED
FLH69539Medicare UPIN
FL51459BMedicare PIN