Provider Demographics
NPI:1740214253
Name:REDDY, BALEED VISHNU VARDHAN (MD)
Entity Type:Individual
Prefix:
First Name:BALEED VISHNU
Middle Name:VARDHAN
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16557207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937221Medicaid
LA1595110OtherEMERGENCY LA MEDICAID
AL12549OtherHEALTHSPRING OF ALABAMA
AL010033CF43756OtherSECTION 1011
AL220010596OtherRAILROAD MEDICARE
AL000084769OtherBLUE CROSS
AL000084769Medicaid
MS00124571OtherMISSISSIPPI MEDICAID
ALF43756OtherVIVA
AL051534744OtherBLUE CROSS
AL000084769Medicare ID - Type Unspecified