Provider Demographics
NPI:1215029400
Name:REDDY, PADMA VENUAOPALA (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:VENUAOPALA
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 1:7415 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429
Mailing Address - Country:US
Mailing Address - Phone:352-795-1415
Mailing Address - Fax:352-795-6801
Practice Address - Street 1:7415 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-795-1415
Practice Address - Fax:352-795-6801
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053251207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250407300Medicaid
07032OtherBC
FL063386100Medicaid
C58005Medicare UPIN
07032Medicare ID - Type Unspecified
FL250407300Medicaid