Provider Demographics
NPI:1780766030
Name:REDDY, PUSHPA Y (MD)
Entity type:Individual
Prefix:
First Name:PUSHPA
Middle Name:Y
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15514 CONIFER BAY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059
Mailing Address - Country:US
Mailing Address - Phone:281-338-1815
Mailing Address - Fax:281-316-2539
Practice Address - Street 1:7 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4123
Practice Address - Country:US
Practice Address - Phone:281-338-1815
Practice Address - Fax:281-316-2539
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164345401Medicaid
TX8K3690OtherBCBS
H46390Medicare UPIN
TX8B3572Medicare ID - Type Unspecified