Provider Demographics
NPI:1386740678
Name:REDDY, ANURADHA NEELAM (MD)
Entity type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:NEELAM
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANURADHA
Other - Middle Name:N
Other - Last Name:RALAPATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2101 E JEFFERSON ST STE 6W
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-7405
Mailing Address - Fax:
Practice Address - Street 1:3930 WALNUT ST
Practice Address - Street 2:#101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4738
Practice Address - Country:US
Practice Address - Phone:703-591-9320
Practice Address - Fax:703-591-9321
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054971207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5847044Medicaid
285160OtherANTHEM BLUECROSS/BLUESHIE
G50252Medicare UPIN
DCG01377Medicare ID - Type Unspecified
38001514Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA5847044Medicaid