Provider Demographics
NPI:1194914143
Name:D.CHANDRA REDDY, MD. PSC
Entity type:Organization
Organization Name:D.CHANDRA REDDY, MD. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANDRA MOHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-678-5365
Mailing Address - Street 1:793 STEEPLECHASE RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8032
Mailing Address - Country:US
Mailing Address - Phone:270-678-5365
Mailing Address - Fax:270-678-3996
Practice Address - Street 1:440 E HAPPY VALLEY ST
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127
Practice Address - Country:US
Practice Address - Phone:270-773-2121
Practice Address - Fax:270-773-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000062942OtherBCBS
KY64320872Medicaid
KY000000062942OtherBCBS
0956101Medicare PIN