Provider Demographics
NPI:1366445496
Name:ANIREDDY, GIRIDHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRIDHAR
Middle Name:
Last Name:ANIREDDY
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 1:2751 N SCENIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7829
Mailing Address - Country:US
Mailing Address - Phone:575-434-2965
Mailing Address - Fax:575-439-8254
Practice Address - Street 1:2751 N SCENIC DRIVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7829
Practice Address - Country:US
Practice Address - Phone:575-434-2965
Practice Address - Fax:575-439-8254
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM20020255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40302202Medicaid
NMG82403Medicare UPIN
NM344233007Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE