Provider Demographics
NPI:1760618516
Name:REDDY, ROOPIKA MAHASAMUDRAM (MD)
Entity Type:Individual
Prefix:
First Name:ROOPIKA
Middle Name:MAHASAMUDRAM
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAHASAMUDRAM
Other - Middle Name:
Other - Last Name:ROOPIKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2608 KEISER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3333
Mailing Address - Country:US
Mailing Address - Phone:610-685-5864
Mailing Address - Fax:610-929-9395
Practice Address - Street 1:2608 KEISER BLVD
Practice Address - Street 2:
Practice Address - City:WHOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3333
Practice Address - Country:US
Practice Address - Phone:610-685-5864
Practice Address - Fax:610-929-9395
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6360128-1205208M00000X
DEC1-0010463207RP1001X
PAMD456105207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1760618516Medicaid
DE1760618516Medicaid