Provider Demographics
NPI:1598760597
Name:REDDY, SOMA NARASIMHA (MD,)
Entity Type:Individual
Prefix:DR
First Name:SOMA
Middle Name:NARASIMHA
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 1:8907 PERIWINKLE BLUE CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5700
Mailing Address - Country:US
Mailing Address - Phone:240-210-1641
Mailing Address - Fax:
Practice Address - Street 1:8907 PERIWINKLE BLUE CT
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-5700
Practice Address - Country:US
Practice Address - Phone:240-210-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17986208000000X
VA0101025624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036211500Medicaid
MD036211500Medicaid
MD7355Medicare ID - Type Unspecified