Provider Demographics
NPI:1437117827
Name:ALLAM, REDDY B (MD)
Entity Type:Individual
Prefix:DR
First Name:REDDY
Middle Name:B
Last Name:ALLAM
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 1:73 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-746-0595
Mailing Address - Fax:973-746-1848
Practice Address - Street 1:73 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-746-0595
Practice Address - Fax:973-746-1848
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06044500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6560504Medicaid
NJ778952Medicare ID - Type Unspecified
NJ6560504Medicaid