Provider Demographics
NPI:1508814443
Name:REDDY, MANOJ SOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:SOMA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7801 OLD BRANCH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1608
Mailing Address - Country:US
Mailing Address - Phone:301-868-9516
Mailing Address - Fax:301-868-6055
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-868-9516
Practice Address - Fax:301-868-6055
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060974207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015811L66Medicare PIN
I20731Medicare UPIN