Provider Demographics
NPI:1659343523
Name:REDDY, RAVI KANTH (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KANTH
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 1:929 N 2ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3363
Mailing Address - Country:US
Mailing Address - Phone:704-982-9800
Mailing Address - Fax:704-982-5112
Practice Address - Street 1:929 N 2ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3363
Practice Address - Country:US
Practice Address - Phone:704-982-9800
Practice Address - Fax:704-982-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000121207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137F3Medicaid
D38267Medicare UPIN
NC2279906AMedicare PIN
NC89137F3Medicaid
NC1659343523Medicare PIN