Provider Demographics
NPI:1710089412
Name:REDDY, NANDI JITENDER (MD)
Entity Type:Individual
Prefix:
First Name:NANDI
Middle Name:JITENDER
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 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3600
Mailing Address - Fax:717-544-3604
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 116
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3600
Practice Address - Fax:717-544-3604
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12946207R00000X
PAMD439767207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046725005Medicaid
TX8K8055OtherBLUE CROSS
TX046725001Medicaid
TX8C0127Medicare ID - Type Unspecified
TX046725005Medicaid