MEDICARE: DR. KAKULAVARAM VENKAT 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	2085R0203X	Therapeutic Radiology Physician	119336	NY
2	2085R0203X	Therapeutic Radiology Physician	0420008367	VT

General Provider Information

NPI Number	:	1770583619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAKULAVARAM VENKAT REDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 8701
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-0701
Country	:	US
Telephone Number	:	518-271-3220
Fax Number	:	518-271-3459

Provider Business Practice Location Address
First Line	:	2215 BURDETT AVE
Second Line	:	SAMARITIAN HOSPITAL CANCER CARE CENTER
City	:	TROY
State	:	NY
Zip	:	12180-2466
Country	:	US
Telephone Number	:	518-271-3220
Fax Number	:	518-271-3459

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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