Provider Demographics
NPI:1649447509
Name:VATTIPALLY, VIKRAM REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:REDDY
Last Name:VATTIPALLY
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:PO BOX 23469
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3469
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:114 CORPORATE GATEWAY BLVD
Practice Address - Street 2:STE 420
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29420
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273895208600000X
SC88247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery