Provider Demographics
NPI:1710998703
Name:REDDY, PRASANNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANNA
Middle Name:L
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRASANNA
Other - Middle Name:L
Other - Last Name:GINUGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9322 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-3721
Mailing Address - Country:US
Mailing Address - Phone:918-628-2544
Mailing Address - Fax:918-680-3701
Practice Address - Street 1:9322 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-3721
Practice Address - Country:US
Practice Address - Phone:918-628-2544
Practice Address - Fax:918-680-3701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK221482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry