1821068511 NPI number — SUBHASH REDDY M.D.

Table of content: SUBHASH REDDY M.D. (NPI 1821068511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821068511 NPI number — SUBHASH REDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
SUBHASH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1821068511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7806 W JEFFERSON BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46804-4180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-432-7000
Provider Business Mailing Address Fax Number:
260-459-6625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7806 W JEFFERSON BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46804-4180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-432-7000
Provider Business Practice Location Address Fax Number:
260-459-6625
Provider Enumeration Date:
01/25/2006

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: 207RC0000X , with the licence number:  35069550 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 01040891 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RE0797832 . This is a "MEDICARE-VANWERT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0913293 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: RE0797831 . This is a "MEDICARE-PAULDING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 100095070 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000087404 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 110070256 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com