Provider Demographics
NPI:1508898818
Name:REDDY, CHANDRASHEKARA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:CHANDRASHEKARA
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5348
Mailing Address - Country:US
Mailing Address - Phone:864-582-2411
Mailing Address - Fax:864-582-7178
Practice Address - Street 1:750 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5348
Practice Address - Country:US
Practice Address - Phone:864-582-2411
Practice Address - Fax:864-582-7178
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043121207RE0101X
WI47052-20207RE0101X
SC836422083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8432320Medicaid
WA8432320Medicaid
WAAB11720Medicare ID - Type Unspecified