Provider Demographics
NPI:1316911431
Name:REDDY, CHANDRA MOHAN (MD)
Entity type:Individual
Prefix:MR
First Name:CHANDRA
Middle Name:MOHAN
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 STEEPLECHASE RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141
Mailing Address - Country:US
Mailing Address - Phone:270-678-5365
Mailing Address - Fax:270-678-3996
Practice Address - Street 1:440 EAST HAPPY VALLEY ST.
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-8844
Practice Address - Country:US
Practice Address - Phone:270-773-2121
Practice Address - Fax:270-773-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32087207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64320872Medicaid
KY64320872Medicaid