Provider Demographics
NPI:1770583619
Name:REDDY, KAKULAVARAM VENKAT (MD)
Entity type:Individual
Prefix:DR
First Name:KAKULAVARAM
Middle Name:VENKAT
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8701
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-0701
Mailing Address - Country:US
Mailing Address - Phone:518-271-3220
Mailing Address - Fax:518-271-3459
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:SAMARITIAN HOSPITAL CANCER CARE CENTER
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3220
Practice Address - Fax:518-271-3459
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1193362085R0203X
VT04200083672085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B81813Medicare UPIN