Provider Demographics
NPI:1255662276
Name:REDDY, PATEL R (PA)
Entity Type:Individual
Prefix:MR
First Name:PATEL
Middle Name:R
Last Name:REDDY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 RICHMOND RD STE 225A
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4180
Mailing Address - Country:US
Mailing Address - Phone:708-381-9483
Mailing Address - Fax:
Practice Address - Street 1:3355 RICHMOND RD
Practice Address - Street 2:SUITE 225 A
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4100
Practice Address - Country:US
Practice Address - Phone:216-831-1494
Practice Address - Fax:216-831-9931
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002048363A00000X
OH50.005020RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant