Provider Demographics
NPI:1942269766
Name:REDDY, KESHAVPAL G (MD)
Entity Type:Individual
Prefix:DR
First Name:KESHAVPAL
Middle Name:G
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 1:603 DOLLEY MADISON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4282
Mailing Address - Country:US
Mailing Address - Phone:336-632-3505
Mailing Address - Fax:336-632-3503
Practice Address - Street 1:603 DOLLEY MADISON RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4282
Practice Address - Country:US
Practice Address - Phone:336-632-3505
Practice Address - Fax:336-632-3503
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC384152084A0401X
VA01010532282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8970725Medicaid
VA004945221Medicaid
BR0407684OtherDEA LICENSE
VA004945221Medicaid
NC8970725Medicaid
NCE55718Medicare UPIN