Provider Demographics
NPI:1760546014
Name:REDDY, KONDA DEVENDER (MD)
Entity Type:Individual
Prefix:
First Name:KONDA
Middle Name:DEVENDER
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEVENDER
Other - Middle Name:R
Other - Last Name:KONDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3249
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-3249
Mailing Address - Country:US
Mailing Address - Phone:985-641-8008
Mailing Address - Fax:
Practice Address - Street 1:1700 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8062
Practice Address - Country:US
Practice Address - Phone:985-641-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.014534207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348198Medicaid
LA4381946510OtherBLUE CROSS
LA5K789Medicare ID - Type Unspecified
LA1348198Medicaid