Provider Demographics
NPI:1275577678
Name:REDDY, RAJU C (MD)
Entity Type:Individual
Prefix:
First Name:RAJU
Middle Name:C
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 1:4974 HIGBEE AVENUE
Mailing Address - Street 2:STE 209
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2562
Mailing Address - Country:US
Mailing Address - Phone:330-493-4553
Mailing Address - Fax:330-493-3762
Practice Address - Street 1:4974 HIGBEE AVENUE
Practice Address - Street 2:STE 209
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2562
Practice Address - Country:US
Practice Address - Phone:330-493-4553
Practice Address - Fax:330-493-3762
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0430782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7610021Medicaid
OH7610021Medicaid