Provider Demographics
NPI:1245201268
Name:REDDY, VARADAREDDY T (MD)
Entity Type:Individual
Prefix:
First Name:VARADAREDDY
Middle Name:T
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:PO BOX 4157
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4157
Mailing Address - Country:US
Mailing Address - Phone:432-520-9029
Mailing Address - Fax:432-520-2181
Practice Address - Street 1:5001 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703
Practice Address - Country:US
Practice Address - Phone:432-520-9292
Practice Address - Fax:432-520-9299
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF28712085N0904X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120216001Medicaid
TX120216004Medicaid
TX120216001Medicaid
E21734Medicare UPIN
TX120216004Medicaid