Provider Demographics
NPI:1427023878
Name:REDDY, VIJAYA LINGA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:LINGA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LINGA
Other - Middle Name:
Other - Last Name:VIJAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-332-3525
Practice Address - Street 1:16 4TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1340
Practice Address - Country:US
Practice Address - Phone:518-481-2801
Practice Address - Fax:518-481-2689
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19957208800000X
NY122167208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85084OtherBCNC
NC8985084Medicaid
NC201586BOtherPSC MEDICARE PROVIDER #
NCC80765Medicare UPIN
NC8985084Medicaid