Provider Demographics
NPI:1699752543
Name:REDDY, RAGHURAM PATLOLA (MD)
Entity type:Individual
Prefix:DR
First Name:RAGHURAM
Middle Name:PATLOLA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1523
Mailing Address - Country:US
Mailing Address - Phone:614-754-5500
Mailing Address - Fax:614-457-9519
Practice Address - Street 1:3400 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1523
Practice Address - Country:US
Practice Address - Phone:614-754-5500
Practice Address - Fax:614-457-9519
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35089028207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2702052Medicaid
H62452Medicare UPIN
OH2702052Medicaid