Provider Demographics
NPI:1437251675
Name:REDDY, CHERUKU B (MD)
Entity Type:Individual
Prefix:
First Name:CHERUKU
Middle Name:B
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 W TAFT ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-452-3235
Mailing Address - Fax:315-452-5726
Practice Address - Street 1:5112 W TAFT ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-452-3235
Practice Address - Fax:315-452-5726
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2318471207L00000X
NY231847207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231847OtherSTATE LICESE
NYRB4600Medicare PIN