Provider Demographics
NPI:1205029287
Name:REDDY, RAJESH (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
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 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2499
Mailing Address - Country:US
Mailing Address - Phone:808-691-1000
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2499
Practice Address - Country:US
Practice Address - Phone:808-691-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0476207Q00000X
HIMD-23424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA842370942AOtherMEDICAID - MPPG/1107 EAST 66TH
GA842370942DOtherMEDICAID - MPPG/POOLER
GA52320665-003OtherBCBS/SAVANNAH
GA842370942EMedicaid
GA202I081106OtherMEDICARE - URGENTONE
GAP00761167OtherRR MEDICARE FOR MPPG
GA52320665-004OtherBCBS/POOLER
GAP00829211OtherRR MEDICARE FOR URGENTONE
GA842370942COtherMEDICAID - URGENTONE SAVANNAH
GA202I086009OtherMEDICARE - MPPG
GA842370942BOtherMEDICAID - URGENTONE POOLER
SCG63010Medicaid