Provider Demographics
NPI:1124166012
Name:REDDY, GIRIDHAR GOPAL (MD)
Entity type:Individual
Prefix:MR
First Name:GIRIDHAR
Middle Name:GOPAL
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GIRIDHAR
Other - Middle Name:G
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7200 BANCROFT AVE STE 125 A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2415
Mailing Address - Country:US
Mailing Address - Phone:510-777-3846
Mailing Address - Fax:510-777-3806
Practice Address - Street 1:7200 BANCROFT AVE STE 125 A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2415
Practice Address - Country:US
Practice Address - Phone:510-777-3846
Practice Address - Fax:510-777-3806
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA788702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry