Provider Demographics
NPI:1881602621
Name:POREDDY, VIJAYRAMA REDDY (MD)
Entity type:Individual
Prefix:
First Name:VIJAYRAMA
Middle Name:REDDY
Last Name:POREDDY
Suffix:
Gender:M
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:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-671-7482
Mailing Address - Fax:512-244-3179
Practice Address - Street 1:7200 WYOMING SPRINGS DR
Practice Address - Street 2:SUITE 1300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-2273
Practice Address - Fax:512-244-3179
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9434207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1666778-03Medicaid
TX8CM020OtherBCBS IND. NUMBER
TXTXB110429Medicare PIN
DC019900M65Medicare PIN
TX00Y427Medicare PIN
H43014Medicare UPIN