Provider Demographics
NPI:1356385165
Name:REDDY, MANOHAR G (MD)
Entity type:Individual
Prefix:DR
First Name:MANOHAR
Middle Name:G
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2551 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-752-5544
Mailing Address - Fax:321-752-5957
Practice Address - Street 1:2551 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-752-5544
Practice Address - Fax:321-752-5957
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0073885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42287OtherBCBS PROVIDER NUMBER
FL255599900Medicaid
FL42287AMedicare ID - Type Unspecified
FLG63683Medicare UPIN