Provider Demographics
NPI:1023094554
Name:REDDY, SUBASH CHANDER (MD)
Entity type:Individual
Prefix:DR
First Name:SUBASH
Middle Name:CHANDER
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1534 HILLTOP TER
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7900
Mailing Address - Country:US
Mailing Address - Phone:215-725-7600
Mailing Address - Fax:215-725-7700
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-725-7600
Practice Address - Fax:215-725-7700
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037101L207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007410570001Medicaid
C32403Medicare UPIN
161728Medicare ID - Type Unspecified