1245263524 NPI number — DR. SURENDER REDDY EDLA MD

Table of content: KIMBERLY MARIE SCHEHR (NPI 1508747171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245263524 NPI number — DR. SURENDER REDDY EDLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDLA
Provider First Name:
SURENDER
Provider Middle Name:
REDDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245263524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6020 RICHMOND HWY
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22303-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-363-3953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1790 OLD TRAIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ETTERS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17319-9652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-938-6588
Provider Business Practice Location Address Fax Number:
717-938-9601
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101239065 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD429426 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101677202 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7977899 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102470 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 889580 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 187920 . This is a "UNISON-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1879312 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2157513 . This is a "MAMSI-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50061854 . This is a "CAPITAL BLUE CROSS-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50083184 . This is a "CAPITAL BLUE CROSS-WMG WFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P006944 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20055006 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 205115 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 261035 . This is a "UNISON-WMG WFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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