Provider Demographics
NPI:1801006176
Name:REDDY, ANURADHA (MD)
Entity type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANURADHA
Other - Middle Name:
Other - Last Name:KUDUMALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2017 JEFFERSON ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2419
Mailing Address - Country:US
Mailing Address - Phone:540-981-8025
Mailing Address - Fax:540-853-0511
Practice Address - Street 1:2017 JEFFERSON ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2419
Practice Address - Country:US
Practice Address - Phone:540-981-8025
Practice Address - Fax:540-853-0511
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012417742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00448243OtherRAILROAD MEDICARE
VAPAROtherUBH
VAPAROtherUMWA
VAPAROtherAETNA
VAPAROtherVALUE OPTIONS
VA2417143OtherCIGNA
VA540506332027OtherTRICARE
VA1801006176Medicaid
VAPAROtherOPTIMA
VA540506332027OtherTRICARE
VAPAROtherVALUE OPTIONS