Provider Demographics
NPI:1841273679
Name:REDDY, JAIVEER T (MD)
Entity type:Individual
Prefix:DR
First Name:JAIVEER
Middle Name:T
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:82 BARNETT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1262
Mailing Address - Country:US
Mailing Address - Phone:814-849-8858
Mailing Address - Fax:814-849-3741
Practice Address - Street 1:82 BARNETT ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1262
Practice Address - Country:US
Practice Address - Phone:814-849-8858
Practice Address - Fax:814-849-3741
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD015261E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1043403421OtherTRAVELERS MEDICARE
PA0006479860001Medicaid
PA1043403421OtherUMWA
PAC30104Medicare UPIN
PA1043403421OtherUMWA