Provider Demographics
NPI:1962465385
Name:REDDY, SAMYUKTHA C (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMYUKTHA
Middle Name:C
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6452
Mailing Address - Country:US
Mailing Address - Phone:256-885-2222
Mailing Address - Fax:256-885-2223
Practice Address - Street 1:400 WHITESPORT DR SW
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6452
Practice Address - Country:US
Practice Address - Phone:256-885-2222
Practice Address - Fax:256-885-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10773207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000038457Medicaid
AL110194866OtherRAILROAD MEDICARE
AL38457OtherBLUE CROSS BLUE SHIELD
AL000038457Medicare ID - Type Unspecified
ALC78690Medicare UPIN