Provider Demographics
NPI:1144274184
Name:REDDY, GUNDALA S (MD)
Entity type:Individual
Prefix:MR
First Name:GUNDALA
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 E YOSEMITE AVE
Mailing Address - Street 2:STE C
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8221
Mailing Address - Country:US
Mailing Address - Phone:209-724-0316
Mailing Address - Fax:209-724-0318
Practice Address - Street 1:1390 E YOSEMITE AVE STE C
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8221
Practice Address - Country:US
Practice Address - Phone:209-724-0316
Practice Address - Fax:209-724-0318
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A710290Medicaid
CA00A710290OtherBS OF CA
CA050075305Medicare PIN
CA00A710292Medicare PIN
CA00A710290Medicare PIN
H14938Medicare UPIN
CA00A710290Medicaid