Provider Demographics
NPI:1417059056
Name:ALUGUBELLI, VENKATREDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATREDDY
Middle Name:
Last Name:ALUGUBELLI
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 1:3759 W AUGUSTA PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-7822
Mailing Address - Country:US
Mailing Address - Phone:352-746-1515
Mailing Address - Fax:352-746-7767
Practice Address - Street 1:3737 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3504
Practice Address - Country:US
Practice Address - Phone:352-746-1515
Practice Address - Fax:352-746-7767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055207207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080115776OtherRAILROAD MEDICARE PIN #
FL037515200Medicaid
FLCN2848OtherRAILROAD MEDICARE GROUP
FLE46931Medicare UPIN
FL080115776OtherRAILROAD MEDICARE PIN #