Provider Demographics
NPI:1619997939
Name:REDDY, GADDAM NARESH (MD)
Entity Type:Individual
Prefix:
First Name:GADDAM
Middle Name:NARESH
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:PO BOX 993215
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-3215
Mailing Address - Country:US
Mailing Address - Phone:530-243-4967
Mailing Address - Fax:530-243-8742
Practice Address - Street 1:1825 SONOMA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2519
Practice Address - Country:US
Practice Address - Phone:530-243-8667
Practice Address - Fax:530-243-8742
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422520Medicaid
CA00A422520OtherBLUE SHIELD
CA00A422520Medicaid
CA00A422520OtherBLUE SHIELD