Provider Demographics
NPI:1962671586
Name:GAUTHAM GUMMADI REDDY MD LIMITED
Entity Type:Organization
Organization Name:GAUTHAM GUMMADI REDDY MD LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTHAM
Authorized Official - Middle Name:GUMMADI
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-385-7001
Mailing Address - Street 1:PO BOX 531352
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-1352
Mailing Address - Country:US
Mailing Address - Phone:027-385-7001
Mailing Address - Fax:702-385-7001
Practice Address - Street 1:2540 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5616
Practice Address - Country:US
Practice Address - Phone:702-385-7001
Practice Address - Fax:702-385-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36155Medicare PIN
NVH56711Medicare UPIN