Provider Demographics
NPI:1437169042
Name:REDDY, VENKAT MANORANJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:MANORANJAN
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 1:4433 CORPORATION LN STE 195
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3363
Mailing Address - Country:US
Mailing Address - Phone:757-622-7000
Mailing Address - Fax:757-623-6708
Practice Address - Street 1:4433 CORPORATION LN STE 195
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3363
Practice Address - Country:US
Practice Address - Phone:757-622-7000
Practice Address - Fax:757-623-6708
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051339208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6303251Medicaid
VACC1972Medicare PIN
VAC04656Medicare PIN
VAF30105Medicare UPIN