Provider Demographics
NPI:1679561351
Name:REDDY, JAYAPAL G (MD)
Entity Type:Individual
Prefix:
First Name:JAYAPAL
Middle Name:G
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7807
Practice Address - Street 1:4100 JOHNSON RD STE 202
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2372
Practice Address - Country:US
Practice Address - Phone:740-282-8746
Practice Address - Fax:740-282-2800
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19954208600000X
OHOH35077519208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7300111000Medicaid
OH2142578Medicaid
OHH11590Medicare UPIN
WVWV2322AMedicare PIN
OHH154230Medicare PIN