Provider Demographics
NPI:1982690996
Name:REDDY, INDIRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:M
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:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-783-4888
Mailing Address - Fax:919-783-4887
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:SUITE 314
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-858-0892
Practice Address - Fax:919-342-3472
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00402207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137XJOtherBCBS
NCD6259OtherMEDCOST
NC89137XJMedicaid
NC259793OtherWELLPATH
NC7395172OtherAETNA
NC137XJOtherBCBS
NC2032104BMedicare PIN