Provider Demographics
NPI:1245263524
Name:EDLA, SURENDER REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:SURENDER
Middle Name:REDDY
Last Name:EDLA
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 1:6020 RICHMOND HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2157
Mailing Address - Country:US
Mailing Address - Phone:443-363-3953
Mailing Address - Fax:
Practice Address - Street 1:1790 OLD TRAIL RD
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9652
Practice Address - Country:US
Practice Address - Phone:717-938-6588
Practice Address - Fax:717-938-9601
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239065207Q00000X
PAMD429426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101677202 0001Medicaid
PA7977899OtherAETNA
PA102470OtherGEISINGER
MD889580OtherCAREFIRST MD BCBS
PA187920OtherUNISON-WMG
PA1879312OtherHIGHMARK BLUE SHIELD
PA2157513OtherMAMSI-WMG
PA50061854OtherCAPITAL BLUE CROSS-WMG
PA50083184OtherCAPITAL BLUE CROSS-WMG WFM
PAP006944OtherGATEWAY-WMG
PA20055006OtherAMERIHEALTH MERCY-WMG
PA205115OtherJOHNS HOPKINS
PA261035OtherUNISON-WMG WFM
PA102760FLTMedicare PIN
MD889580OtherCAREFIRST MD BCBS
PA2157513OtherMAMSI-WMG