Provider Demographics
NPI:1457398166
Name:REDDY, CHANDRA GAVVA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:GAVVA
Last Name:REDDY
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 1:3702 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5507
Mailing Address - Country:US
Mailing Address - Phone:812-234-0098
Mailing Address - Fax:812-234-3873
Practice Address - Street 1:3702 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5507
Practice Address - Country:US
Practice Address - Phone:812-234-0098
Practice Address - Fax:812-234-3873
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041138A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01041138BOtherCONTROLLED SUBSTANCE
IN000000089362OtherANTHEM
IN000000089362OtherANTHEM
BR2564157OtherFEDERAL DEA
IN01041138BOtherCONTROLLED SUBSTANCE