Provider Demographics
NPI:1902863384
Name:REDDY, SUBASHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBASHRI
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUBASHRI
Other - Middle Name:
Other - Last Name:SUNDARARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1325 PEPPERTREE CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-3269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 DEFENSE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2926
Practice Address - Country:US
Practice Address - Phone:410-721-5280
Practice Address - Fax:410-721-2243
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0405217OtherEVERCARE
MD521973185OtherUNITED HEALTCARE
MD521973185OtherPHCS
MD277779OtherMAMSI/ALLIANCE
MD7690431OtherAETNA
MD0406167OtherUNTD HLTHC AMERI CHOICE
MD521973185OtherFIDELITY PMG
MD10136OtherKAISER
MD517676OtherNCPPO
MD402797300Medicaid
MD521973185OtherCOVENTRY HLTH OF DELAWARE
MD61876602OtherBCBS OF MARYLAND
MD67064000000OtherPREFERRED HEALTH
DC25970031OtherBCBSNCA
MD3022668OtherAETNA US HEALTHCARE
MD9716197001OtherCIGNA
MD402797300Medicaid
MDH70409Medicare UPIN
MD454LM989Medicare PIN
MD0405217OtherEVERCARE
MD10136OtherKAISER
MD521973185OtherUNITED HEALTCARE