Provider Demographics
NPI:1609828037
Name:REDDY, SATHYANARAYAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SATHYANARAYAN
Middle Name:M
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:527 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-933-3830
Mailing Address - Fax:304-933-3837
Practice Address - Street 1:527 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-933-3830
Practice Address - Fax:304-933-3837
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV16388207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV16388AOtherHEALTH PLAN
WV000094799OtherBLUE CROSS BLUE SHIELD
WV0043549000Medicaid
WV000094799OtherBLUE CROSS BLUE SHIELD
WV0741251Medicare ID - Type Unspecified
WV9919981Medicare PIN