Provider Demographics
NPI:1124133780
Name:YERUVA, MARREDDY (MD)
Entity type:Individual
Prefix:DR
First Name:MARREDDY
Middle Name:
Last Name:YERUVA
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 1:201 REECEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1542
Mailing Address - Country:US
Mailing Address - Phone:610-383-8351
Mailing Address - Fax:610-383-8024
Practice Address - Street 1:201 REECEVILLE RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1542
Practice Address - Country:US
Practice Address - Phone:610-383-8351
Practice Address - Fax:610-383-8024
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016564208M00000X
PAMD449377208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEI09541Medicare UPIN