Provider Demographics
NPI:1568514289
Name:REDDY, HARI CHARAN PABBATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:HARI CHARAN
Middle Name:PABBATHI
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 1:1746 COLE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3208
Mailing Address - Country:US
Mailing Address - Phone:614-638-0139
Mailing Address - Fax:
Practice Address - Street 1:1746 COLE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3208
Practice Address - Country:US
Practice Address - Phone:614-638-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD653542085N0700X
OH35.0838102085R0202X
MI43010933312085R0202X
CO494642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022855010001Medicaid
OH2803096Medicaid
COCOA104862Medicare PIN
COCOA104861Medicare PIN
PA1022855010001Medicaid
OH2803096Medicaid
OH4228234Medicare PIN
COP00906784Medicare PIN