Provider Demographics
NPI:1336461763
Name:MAHENDER M REDDY MD INC
Entity Type:Organization
Organization Name:MAHENDER M REDDY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-863-5263
Mailing Address - Street 1:7330 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6711
Mailing Address - Country:US
Mailing Address - Phone:727-862-9470
Mailing Address - Fax:727-862-6489
Practice Address - Street 1:7330 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6711
Practice Address - Country:US
Practice Address - Phone:727-862-9470
Practice Address - Fax:727-862-6489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068848207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378212300Medicaid
FL27515AMedicare PIN
FLG10234Medicare UPIN