Provider Demographics
NPI:1316063209
Name:NAGARATNA REDDY M.D
Entity type:Organization
Organization Name:NAGARATNA REDDY M.D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-252-1000
Mailing Address - Street 1:217 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2527
Mailing Address - Country:US
Mailing Address - Phone:985-252-1000
Mailing Address - Fax:985-252-1003
Practice Address - Street 1:3407 HIGHWAY 70 S
Practice Address - Street 2:
Practice Address - City:PIERRE PART
Practice Address - State:LA
Practice Address - Zip Code:70339-4524
Practice Address - Country:US
Practice Address - Phone:225-473-3931
Practice Address - Fax:225-473-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15680R207R00000X
LA193832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948292Medicaid
5F973OtherMEDICARE PART B
5F973OtherMEDICARE PART B
LAD66125Medicare UPIN
LA193832Medicare Oscar/Certification
LA5F973Medicare PIN