Provider Demographics
NPI:1225028228
Name:REDDY, ASHOK KOTA (MD)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:KOTA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:806 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3657
Practice Address - Country:US
Practice Address - Phone:505-842-6575
Practice Address - Fax:505-764-8796
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0164207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00241847OtherRRB MEDICARE RAILROAD
AZ956724Medicaid
NMNM009W34OtherBC BS OF NM
NM28353854Medicaid
NMI00516Medicare UPIN
NM28353854Medicaid