Provider Demographics
NPI:1720134521
Name:REDDY, VENKAT K (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VENKATA
Other - Middle Name:K
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1804 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2206
Mailing Address - Country:US
Mailing Address - Phone:615-329-9321
Mailing Address - Fax:615-329-9123
Practice Address - Street 1:1804 STATE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2206
Practice Address - Country:US
Practice Address - Phone:615-329-9321
Practice Address - Fax:615-329-9123
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG49184Medicare UPIN
TN3832261Medicare ID - Type Unspecified