Provider Demographics
NPI:1194835975
Name:REDDY, VENUGOPALA A (MD)
Entity Type:Individual
Prefix:MR
First Name:VENUGOPALA
Middle Name:A
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 1:3400 N LECANTO HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3548
Mailing Address - Country:US
Mailing Address - Phone:352-746-2227
Mailing Address - Fax:352-746-3587
Practice Address - Street 1:3400 N LECANTO HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3548
Practice Address - Country:US
Practice Address - Phone:352-746-2227
Practice Address - Fax:352-746-3587
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN2848OtherRAILROAD MEDICARE GROUP
FL07316OtherBCBS OF FLORIDA
FL052196500Medicaid
FL110159321OtherRAILROAD MEDICARE PIN
FL660071900Medicaid
FLCN2848OtherRAILROAD MEDICARE GROUP
FL07316WMedicare PIN