Provider Demographics
NPI:1518028877
Name:NEELUPALLI BOJJI REDDY, MD PA
Entity Type:Organization
Organization Name:NEELUPALLI BOJJI REDDY, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEELUPALLI
Authorized Official - Middle Name:BOJJI
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:410-420-2108
Mailing Address - Street 1:715 S SHAMROCK RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4457
Mailing Address - Country:US
Mailing Address - Phone:410-420-2108
Mailing Address - Fax:410-420-2109
Practice Address - Street 1:715 S SHAMROCK RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4457
Practice Address - Country:US
Practice Address - Phone:410-420-2108
Practice Address - Fax:410-420-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD437602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E368 0001OtherBCBS FEDERAL
MD191941500Medicaid
52927305OtherCAREFIRST BCBS
MD191941500Medicaid