Provider Demographics
NPI:1659310431
Name:REDDIX, IRANCE' (MD)
Entity Type:Individual
Prefix:DR
First Name:IRANCE'
Middle Name:
Last Name:REDDIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 KENJAC RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1323
Mailing Address - Country:US
Mailing Address - Phone:318-348-5622
Mailing Address - Fax:410-630-5368
Practice Address - Street 1:644 E 33RD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3504
Practice Address - Country:US
Practice Address - Phone:410-871-8537
Practice Address - Fax:410-630-5368
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412870200Medicaid
MD412870200Medicaid