Provider Demographics
NPI:1013122035
Name:VIJAYALAKSHMI REDDY MD LLC
Entity Type:Organization
Organization Name:VIJAYALAKSHMI REDDY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-998-3920
Mailing Address - Street 1:10320 CASTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5865
Mailing Address - Country:US
Mailing Address - Phone:443-794-6871
Mailing Address - Fax:410-462-5079
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:STE 312
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-225-4455
Practice Address - Fax:410-462-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD124800601Medicaid
MD363MMedicare PIN
MDG22703Medicare UPIN