Provider Demographics
NPI:1205041969
Name:REDDY, MADHAVI G (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:G
Last Name:REDDY
Suffix:
Gender:F
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-283-8193
Mailing Address - Fax:704-283-7252
Practice Address - Street 1:613 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5124
Practice Address - Country:US
Practice Address - Phone:704-283-8193
Practice Address - Fax:704-283-7252
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT184979207Q00000X
NC2008-00704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909216Medicaid
SCQ04008Medicaid
SCQ04008Medicaid
NC2022328RMedicare PIN
NCNC0134AMedicare PIN
NC2022328HMedicare PIN
NC2022328NMedicare PIN
NC2022328FMedicare PIN
NCNC1022BMedicare PIN
NCNC0134BMedicare PIN
NCNC0134CMedicare PIN
NC2022328GMedicare PIN
NC5909216Medicaid