Provider Demographics
NPI:1932398120
Name:SUJATA REDDY, MD., PLLC
Entity Type:Organization
Organization Name:SUJATA REDDY, MD., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-659-2530
Mailing Address - Street 1:930 HAPPY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1332
Mailing Address - Country:US
Mailing Address - Phone:270-659-2530
Mailing Address - Fax:270-659-2740
Practice Address - Street 1:930 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1332
Practice Address - Country:US
Practice Address - Phone:270-659-2530
Practice Address - Fax:270-659-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36781207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7189Medicare PIN