Provider Demographics
NPI:1164430476
Name:REDDY, GAYATHRI M (MD)
Entity type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:EAGLE PAVILION, FIRST FLOOR
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-1803
Mailing Address - Fax:571-231-6617
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:EAGLE PAVILION, FIRST FLOOR
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-1803
Practice Address - Fax:571-231-6617
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-05-17
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Provider Licenses
StateLicense IDTaxonomies
VA0101240383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00363727OtherMEDICARE RR
VA0101240383OtherVA STATE LICENSE
P00363727OtherMEDICARE RR
VA0101240383OtherVA STATE LICENSE