Provider Demographics
NPI:1972619146
Name:REDDY, MADHUSUDAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MADHUSUDAN
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-465-6600
Mailing Address - Fax:510-839-0806
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-465-6600
Practice Address - Fax:510-839-0806
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17823363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA178230Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAQ65412Medicare UPIN