Provider Demographics
NPI:1457360950
Name:REDDY, RAMAKRISHNA TN (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMAKRISHNA
Middle Name:TN
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAM
Other - Middle Name:T
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1360 W. SIXTH STREET
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-547-9922
Mailing Address - Fax:310-547-4673
Practice Address - Street 1:1360 W. SIXTH STREET
Practice Address - Street 2:STE. 200
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-547-9922
Practice Address - Fax:310-547-4673
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50362207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA50362DMedicare ID - Type Unspecified
CAWA50362CMedicare ID - Type Unspecified
CAWA50362IMedicare ID - Type Unspecified
CAE32771Medicare UPIN
CAWA50362LMedicare ID - Type Unspecified
CAWA50362KMedicare ID - Type Unspecified
CAWA50362GMedicare ID - Type Unspecified