Provider Demographics
NPI:1407968167
Name:REDDY, ADISESHA B (MD)
Entity Type:Individual
Prefix:
First Name:ADISESHA
Middle Name:B
Last Name:REDDY
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 1:100 RICE MINE RD N STE E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2375
Mailing Address - Country:US
Mailing Address - Phone:205-345-0010
Mailing Address - Fax:205-752-1175
Practice Address - Street 1:100 RICE MINE RD N STE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2375
Practice Address - Country:US
Practice Address - Phone:205-345-0010
Practice Address - Fax:205-986-0081
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10176207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521250Medicare ID - Type Unspecified
ALC72975Medicare UPIN