Provider Demographics
NPI:1255400727
Name:REDDY, WILLIAM D JR (LAC, DIPLAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:REDDY
Suffix:JR
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8100 INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4870
Practice Address - Country:US
Practice Address - Phone:571-472-1440
Practice Address - Fax:571-472-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0121000177171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist