Provider Demographics
NPI:1770580508
Name:REDDY, NAGARATNA (MD)
Entity type:Individual
Prefix:
First Name:NAGARATNA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAGARATNA
Other - Middle Name:C
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:217 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2527
Mailing Address - Country:US
Mailing Address - Phone:225-473-3931
Mailing Address - Fax:225-473-3289
Practice Address - Street 1:217 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2527
Practice Address - Country:US
Practice Address - Phone:225-473-3931
Practice Address - Fax:225-473-3289
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05775R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1320251Medicaid
LA54862F973Medicare Oscar/Certification
LAD66125Medicare UPIN