Provider Demographics
NPI:1518965094
Name:MADIREDDY, NAGA PRASUNA (MD)
Entity Type:Individual
Prefix:
First Name:NAGA
Middle Name:PRASUNA
Last Name:MADIREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 LOONEY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4149
Mailing Address - Country:US
Mailing Address - Phone:937-773-0012
Mailing Address - Fax:937-773-3712
Practice Address - Street 1:280 LOONEY ROAD
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4149
Practice Address - Country:US
Practice Address - Phone:937-773-0012
Practice Address - Fax:937-773-3712
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081903M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500118Medicaid
OH2500118Medicaid
OHH92841Medicare UPIN