Provider Demographics
NPI:1063490803
Name:C G REDDY MD INC
Entity type:Organization
Organization Name:C G REDDY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GURU
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-653-9476
Mailing Address - Street 1:1973 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9353
Mailing Address - Country:US
Mailing Address - Phone:740-653-9476
Mailing Address - Fax:740-653-9478
Practice Address - Street 1:1973 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9353
Practice Address - Country:US
Practice Address - Phone:740-653-9476
Practice Address - Fax:740-653-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041941261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000118003OtherANTHEM
OH0420477Medicaid
OH9304144Medicare PIN
OHB77518Medicare UPIN