Provider Demographics
NPI:1992264121
Name:REDDY, MATTA TEMUJIN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTA
Middle Name:TEMUJIN
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TEMUJIN
Other - Middle Name:REDDY
Other - Last Name:MATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:108 HEDDON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2457
Practice Address - Country:US
Practice Address - Phone:484-560-3506
Practice Address - Fax:878-201-9145
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88503208M00000X, 207Q00000X
SCMD88503207Q00000X
RI88503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine