Provider Demographics
NPI:1679722607
Name:REDDY, ARUNA K (MD)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:K
Last Name:REDDY
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-6594
Mailing Address - Fax:503-494-5385
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-6594
Practice Address - Fax:503-494-5385
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0901207RH0003X
WAMD60225400207RH0003X
SC32789207RH0003X
FLME102248207RH0003X
ORMD202173207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198490801Medicaid
TX198490803Medicaid
TX198490802Medicaid
TX8L6431Medicare PIN
TX198490802Medicaid
TX8L4342Medicare PIN