Provider Demographics
NPI:1386219004
Name:KATAMREDDY, REWANTH REDDY (MD)
Entity Type:Individual
Prefix:
First Name:REWANTH
Middle Name:REDDY
Last Name:KATAMREDDY
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:SAINT MICHAELS MEDICAL CENTER 111 CENTRAL AVENUE
Mailing Address - Street 2:FLOOR D7 MEDICAL EDUCATION
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SAINT MICHAELS MEDICAL CENTER 111 CENTRAL AVENUE
Practice Address - Street 2:FLOOR D7 MEDICAL EDUCATION
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-877-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program