MEDICARE: MADHAVI THUKIVAKAM REDDY MD

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
1	207RC0000X	Cardiovascular Disease Physician	MD.201257	LA
2	207R00000X	Internal Medicine Physician	036-116563	IL
3	207RC0000X	Cardiovascular Disease Physician	MD446760	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1245382704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHAVI THUKIVAKAM REDDY MD

Provider Business Mailing Address
First Line	:	33 EAST CHESTNUT AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2713
Country	:	US
Telephone Number	:	215-248-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 EAST CHESTNUT AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2713
Country	:	US
Telephone Number	:	215-248-1350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	10/17/2012

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