Provider Demographics
NPI:1538199104
Name:REDDY, JAGADEESHWAR KORIPELLI (MD)
Entity type:Individual
Prefix:DR
First Name:JAGADEESHWAR
Middle Name:KORIPELLI
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-7149
Mailing Address - Fax:209-726-0134
Practice Address - Street 1:374 WEST OLIVE AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-383-3076
Practice Address - Fax:209-383-6301
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77851207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A778510Medicaid
CA00A778510Medicaid
CA00A778515Medicare PIN
CAH66720Medicare UPIN