Provider Demographics
NPI:1356375927
Name:REDDY, MURALIDHAR T (MD)
Entity type:Individual
Prefix:DR
First Name:MURALIDHAR
Middle Name:T
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:79 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4523
Mailing Address - Country:US
Mailing Address - Phone:518-952-8408
Mailing Address - Fax:518-952-8287
Practice Address - Street 1:556 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1105
Practice Address - Country:US
Practice Address - Phone:585-442-8422
Practice Address - Fax:585-442-8494
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
NY130268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid
NY03008239Medicaid