Provider Demographics
NPI:1962449520
Name:REDDY CARDIOVASCULAR ASSOCIATES PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:REDDY CARDIOVASCULAR ASSOCIATES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VARDHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-266-2340
Mailing Address - Street 1:504 GREENBRIER CT
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3335
Mailing Address - Country:US
Mailing Address - Phone:740-346-0554
Mailing Address - Fax:
Practice Address - Street 1:3150 JOHNSON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2307
Practice Address - Country:US
Practice Address - Phone:740-266-3240
Practice Address - Fax:740-266-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079717208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2670471Medicaid
WV3810002528Medicaid
Q74970Medicare UPIN
WV3810002528Medicaid
OH2670471Medicaid
G28241Medicare UPIN