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NPI Code Detail

MEDICARE: DR. AJAY REDDIVARI M.D.

MEDICARE: DR. AJAY REDDIVARI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician35-06-0503ROH
2207RI0011XInterventional Cardiology Physician35060503OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063494086
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AJAY REDDIVARI M.D.
Provider Business Mailing Address
First Line : 1380 E STROOP RD
Second Line :
City : KETTERING
State : OH
Zip : 45429-4926
Country : US
Telephone Number : 937-294-4356
Fax Number : 937-297-2381
Provider Business Practice Location Address
First Line : 1380 E STROOP RD
Second Line :
City : KETTERING
State : OH
Zip : 45429-4926
Country : US
Telephone Number : 937-294-4356
Fax Number : 937-297-2381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 01/04/2021

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