Provider Demographics
NPI:1376750059
Name:VEMIREDDY, ROOPA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOPA
Middle Name:
Last Name:VEMIREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2037
Mailing Address - Country:US
Mailing Address - Phone:650-299-2000
Mailing Address - Fax:702-759-8779
Practice Address - Street 1:1150 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2037
Practice Address - Country:US
Practice Address - Phone:650-299-2000
Practice Address - Fax:702-384-1815
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK303512085R0202X
CAA1204782085R0202X
390200000X
NV150422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01292451OtherRR MEDICARE DR
CA1376750059Medicaid
CAP01285917OtherRR MEDICARE DRS
CACB203953Medicare PIN
CACA105227Medicare PIN
CACA105226Medicare PIN
CAP01285917OtherRR MEDICARE DRS