Provider Demographics
NPI:1326029588
Name:REDDY, RAVICHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:RAVICHANDRA
Middle Name:
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 1:1 WEBSTER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1364
Mailing Address - Country:US
Mailing Address - Phone:845-790-6165
Mailing Address - Fax:845-345-9966
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:ATRIUM AT ST FRANCIS #301
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-483-5865
Practice Address - Fax:845-483-5787
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203889208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704030Medicaid
NY633428Medicare ID - Type Unspecified
NYG33428Medicare UPIN