Provider Demographics
NPI:1386724672
Name:REDDY, RAMA (MD)
Entity type:Individual
Prefix:DR
First Name:RAMA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:#609
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-759-1111
Mailing Address - Fax:973-759-0894
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:#609
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-759-1111
Practice Address - Fax:973-759-0894
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06283700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6950400Medicaid
NJG21262Medicare UPIN
NJ831634Medicare ID - Type Unspecified