Provider Demographics
NPI:1194037507
Name:GANGIREDDY, VENU GOPALA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VENU
Middle Name:GOPALA REDDY
Last Name:GANGIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VENU GOPALA REDDY
Other - Middle Name:
Other - Last Name:G
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-978-3549
Practice Address - Street 1:555 KITCHINGS DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3576
Practice Address - Country:US
Practice Address - Phone:704-978-1144
Practice Address - Fax:704-978-1148
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69811207R00000X
WV27062207RG0100X
NC2022-01096207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine