Provider Demographics
NPI:1598767717
Name:REDDY, NARENDRANATH A (MD)
Entity Type:Individual
Prefix:DR
First Name:NARENDRANATH
Middle Name:A
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 1:301 W HUNTINGTON DR
Mailing Address - Street 2:SUITE #327
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-447-8129
Mailing Address - Fax:626-447-2094
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:STE 327
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1501
Practice Address - Country:US
Practice Address - Phone:626-447-8129
Practice Address - Fax:626-447-2094
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-04-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-05-11
Provider Licenses
StateLicense IDTaxonomies
CAA31701207RE0101X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A31701Medicaid
CA00A31701Medicare ID - Type Unspecified
CA000A31701Medicaid