MEDICARE: DR. INDIRA M. REDDY 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
1	207RG0100X	Gastroenterology Physician	2004-00402	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137XJ	OTHER	NC	BCBS
2	D6259	OTHER	NC	MEDCOST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	259793	OTHER	NC	WELLPATH
5	7395172	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1982690996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDIRA M. REDDY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 18563
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27619-8563
Country	:	US
Telephone Number	:	919-783-4888
Fax Number	:	919-783-4887

Provider Business Practice Location Address
First Line	:	530 NEW WAVERLY PL
Second Line	:	SUITE 314
City	:	CARY
State	:	NC
Zip	:	27518-7414
Country	:	US
Telephone Number	:	919-858-0892
Fax Number	:	919-342-3472

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	03/08/2016

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