Provider Demographics
NPI:1497948640
Name:REDDY, ARAVINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:ARAVINDA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARAVINDA
Other - Middle Name:
Other - Last Name:PULAKURTHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1089 NEW DOVER RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1421
Mailing Address - Country:US
Mailing Address - Phone:732-247-2675
Mailing Address - Fax:732-645-7457
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-289-8340
Practice Address - Fax:908-576-3456
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201461207R00000X
NJ25MA08807500207R00000X, 207RN0300X
TXM9585207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0255467Medicaid
NJ3815294000OtherAMERIHEALTH
NJ0255467Medicaid
NJ800288BB4Medicare PIN