Provider Demographics
NPI:1306957436
Name:REDDY, CHENNA (MD)
Entity type:Individual
Prefix:
First Name:CHENNA
Middle Name:
Last Name:REDDY
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:P.O. BOX 8500-1601
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1601
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-815-7814
Practice Address - Street 1:433 BELLEVUE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4501
Practice Address - Country:US
Practice Address - Phone:609-815-2677
Practice Address - Fax:609-815-2682
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03387000207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0972801Medicaid
NJD18433Medicare UPIN
NJ0972801Medicaid