Provider Demographics
NPI:1538248372
Name:PEDDAREDDIGARI, VIJAY GOPAL REDDY (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:GOPAL REDDY
Last Name:PEDDAREDDIGARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:215-615-5858
Mailing Address - Fax:215-349-8144
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:77210-4439
Practice Address - Country:US
Practice Address - Phone:215-615-5858
Practice Address - Fax:215-349-8144
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD428125207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology