Provider Demographics
NPI:1568450245
Name:REDDY, VARDHAN (MD)
Entity Type:Individual
Prefix:
First Name:VARDHAN
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GREENBRIER CT
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3335
Mailing Address - Country:US
Mailing Address - Phone:740-266-3240
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY STE 408
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5055
Practice Address - Country:US
Practice Address - Phone:740-266-3240
Practice Address - Fax:304-266-3244
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4172702086S0129X
OHOH350797172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2461992Medicaid
WV1840202000Medicaid
OH9353511Medicare ID - Type Unspecified
OH4070472Medicare ID - Type Unspecified
ID02931Medicare ID - Type UnspecifiedVASCULAR LAB
OH2461992Medicaid
WV4161091Medicare ID - Type Unspecified