Provider Demographics
NPI:1760611776
Name:NARAVADI, VISHNU VARDHAN REDDY (MD)
Entity Type:Individual
Prefix:
First Name:VISHNU VARDHAN REDDY
Middle Name:
Last Name:NARAVADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3110 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1210
Mailing Address - Country:US
Mailing Address - Phone:304-347-1254
Mailing Address - Fax:304-347-1291
Practice Address - Street 1:2930 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1125
Practice Address - Country:US
Practice Address - Phone:304-351-1700
Practice Address - Fax:304-351-1725
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130658207RG0100X
WV29606207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology