Provider Demographics
NPI:1396809828
Name:SAMYUKTHA C.REDDY,M.D.,P.C.
Entity type:Organization
Organization Name:SAMYUKTHA C.REDDY,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMYUKTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-885-2222
Mailing Address - Street 1:400 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6452
Mailing Address - Country:US
Mailing Address - Phone:256-885-2222
Mailing Address - Fax:256-885-2223
Practice Address - Street 1:400 WHITESPORT DR SW
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6452
Practice Address - Country:US
Practice Address - Phone:256-885-2222
Practice Address - Fax:256-885-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL10773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000038457Medicaid
AL110194866OtherRAILROAD RETIREMENT
AL38457OtherBLUE CROSS BLUE SHIELD
AL110194866OtherRAILROAD RETIREMENT
ALC78690Medicare UPIN