Provider Demographics
NPI:1568776540
Name:KUPPIREDDY, PALLAVI REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PALLAVI REDDY
Middle Name:
Last Name:KUPPIREDDY
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 1:600 GRESHAM DR FL 5
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3198
Mailing Address - Fax:757-388-4242
Practice Address - Street 1:600 GRESHAM DR FL 5
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3198
Practice Address - Fax:757-388-4242
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253180208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10109990OtherOPTIMA HEALTH
VA1568776540OtherVIRGINIA PREMIER HEALTH PLAN
VA1568776540Medicaid
NC1568776540Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VA494178OtherANTHEM BC/BS
VAPAROtherMULTIPLAN
VAPAROtherCIGNA
VAPAROtherAETNA
VA-028OtherTRICARE/CHAMPUS
VA1568776540OtherCOVENTRY NETWORK
VA1568776540OtherUNITED HEALTHCARE
VAPAROtherCORVEL
VA1568776540OtherVIRGINIA PREMIER HEALTH PLAN
VA1568776540OtherUNITED HEALTHCARE