Provider Demographics
NPI:1407031040
Name:GOPAL REDDY M.D., P.C.
Entity Type:Organization
Organization Name:GOPAL REDDY M.D., P.C.
Other - Org Name:NEW MEXICO VASCULAR DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-842-5518
Mailing Address - Street 1:500 WALTER ST NE STE 204
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2543
Mailing Address - Country:US
Mailing Address - Phone:505-842-5518
Mailing Address - Fax:505-247-8509
Practice Address - Street 1:500 WALTER ST NE STE 204
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2543
Practice Address - Country:US
Practice Address - Phone:505-842-5518
Practice Address - Fax:505-247-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77-2372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09449Medicaid
NMD43267Medicare UPIN