Provider Demographics
NPI:1386846582
Name:SRIDHAR P. REDDY, MD PA
Entity Type:Organization
Organization Name:SRIDHAR P. REDDY, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:P
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:512-474-6321
Mailing Address - Street 1:2911 MEDICAL ARTS ST STE 9B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2911 MEDICAL ARTS ST STE 9B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3302
Practice Address - Country:US
Practice Address - Phone:512-474-6321
Practice Address - Fax:512-474-6324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032QSOtherBLUE CROSS BLUE SHIELD
TX710200TX78705OtherBCBS OF MICHIGAN PROVI.ID
TX10659947533OtherGREAT WEST HLTHCARE ID
TX2669771OtherAETNA PROVIDER ID
TX10011874OtherAMERIGROUP PROVIDER ID
TXDA2621OtherMCARE RR GROUP ID
TXP00042032OtherMCARE RAILRD PROVID ID
TX710200TX78705OtherBCBS OF MICHIGAN PROVI.ID
TX2669771OtherAETNA PROVIDER ID
TXP00042032OtherMCARE RAILRD PROVID ID