Provider Demographics
NPI:1972797397
Name:GUNDAREDDY, VENKAT PRADEEP (MD)
Entity Type:Individual
Prefix:
First Name:VENKAT
Middle Name:PRADEEP
Last Name:GUNDAREDDY
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:PO BOX 64264
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4264
Mailing Address - Country:US
Mailing Address - Phone:410-550-5018
Mailing Address - Fax:
Practice Address - Street 1:5200 EASTERN AVE
Practice Address - Street 2:MASON F LORD BUILDING, WEST TOWER, CIMS SUITE 6TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2734
Practice Address - Country:US
Practice Address - Phone:410-550-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070728208M00000X
MDD70728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD035384100Medicaid
MD186509Y82Medicare PIN