Provider Demographics
NPI:1760827133
Name:NAGARATNA REDDY M.D
Entity Type:Organization
Organization Name:NAGARATNA REDDY M.D
Other - Org Name:REDDY FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-473-3931
Mailing Address - Street 1:217 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2527
Mailing Address - Country:US
Mailing Address - Phone:225-473-3931
Mailing Address - Fax:
Practice Address - Street 1:217 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2527
Practice Address - Country:US
Practice Address - Phone:225-473-3931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05775R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357081Medicaid
LA1445118Medicaid
LA1320251Medicaid
LA1948292Medicaid
LA1949248Medicaid
LA1469238Medicaid
LA1626597Medicaid
LA1948144Medicaid
LA1949809Medicaid
LA54862Medicare PIN
LA193813Medicare PIN
LA1949809Medicaid
LA1948292Medicaid
LA1949248Medicaid
LA1469238Medicaid
LA5F973PA51Medicare PIN
LA193838Medicare PIN