Provider Demographics
NPI:1336140326
Name:REDDY, RAGOOR K (MD)
Entity Type:Individual
Prefix:
First Name:RAGOOR
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:6303 ROUTE 30
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6398
Practice Address - Country:US
Practice Address - Phone:724-527-1440
Practice Address - Fax:724-527-6520
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033713E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010903160004Medicaid
PA0010903160004Medicaid
PA137136GFVMedicare ID - Type Unspecified