Provider Demographics
NPI:1760559009
Name:REDDY, ANURADHA DEVUNI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:DEVUNI
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:G
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:10404 KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5852
Mailing Address - Country:US
Mailing Address - Phone:410-461-2239
Mailing Address - Fax:
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:312
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-225-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46305207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW459003OtherBCBS
MDF98056Medicare UPIN
MD403MMedicare ID - Type Unspecified