Provider Demographics
NPI:1770717753
Name:REDDY, VIKRAM B (MD, PHD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:B
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 1:900 CHAPEL ST
Mailing Address - Street 2:APT 509
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2802
Mailing Address - Country:US
Mailing Address - Phone:203-809-2450
Mailing Address - Fax:
Practice Address - Street 1:333 CEDAR ST # LH118
Practice Address - Street 2:YALE UNIVERSITY SCHOOL OF MEDICINE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-785-2616
Practice Address - Fax:203-785-2615
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047800208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery