Provider Demographics
NPI:1376595223
Name:REDDY, PRAKASH PATLOLLA (MD,)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:PATLOLLA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:835 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2335
Mailing Address - Country:US
Mailing Address - Phone:585-368-6550
Mailing Address - Fax:585-368-6540
Practice Address - Street 1:1597 RIDGE RD W
Practice Address - Street 2:SUITE # 301
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2513
Practice Address - Country:US
Practice Address - Phone:585-314-7595
Practice Address - Fax:585-368-0860
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1821522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357497Medicaid
NY0010182152OtherBLUE CHOICE
RC60182152OtherDOCTORS HEALTH PLAN
NYMDG569OtherPREFERRED CARE
E45959Medicare UPIN
NY00357497Medicaid