Provider Demographics
NPI:1316933641
Name:REDDY, SRINIVASA HONAGANAHALLY VENKAT (MD)
Entity type:Individual
Prefix:
First Name:SRINIVASA
Middle Name:HONAGANAHALLY VENKAT
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 1:6740 W DEER VALLEY RD
Mailing Address - Street 2:STE D-107-278
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5953
Mailing Address - Country:US
Mailing Address - Phone:623-341-6539
Mailing Address - Fax:623-215-4254
Practice Address - Street 1:6740 W DEER VALLEY RD
Practice Address - Street 2:STE D-107-278
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5953
Practice Address - Country:US
Practice Address - Phone:623-341-6539
Practice Address - Fax:623-215-4254
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine