Provider Demographics
NPI:1780640102
Name:REDDY, M. NIRANJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:M. NIRANJAN
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6401
Mailing Address - Country:US
Mailing Address - Phone:937-298-8058
Mailing Address - Fax:937-298-5638
Practice Address - Street 1:630 W MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2171
Practice Address - Country:US
Practice Address - Phone:937-283-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071418R207RC0000X
OH35071418207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270957Medicaid
110227392OtherMEDICARE RR
110227392OtherMEDICARE RR
OH2270957Medicaid
OHH232360Medicare PIN
OH4053704Medicare PIN