Provider Demographics
NPI:1619022712
Name:REDDY, SREERANGAPALLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:SREERANGAPALLE
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2424
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2424
Mailing Address - Country:US
Mailing Address - Phone:212-737-0909
Mailing Address - Fax:212-737-3589
Practice Address - Street 1:1049 5TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0115
Practice Address - Country:US
Practice Address - Phone:212-737-0909
Practice Address - Fax:212-737-3589
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00971522Medicaid
NY76D361Medicare ID - Type Unspecified
NY00971522Medicaid