Healthcare Provider Details

I. General information

NPI: 1922448075
Provider Name (Legal Business Name): ASWANTH REDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ROGERS AVE STE 200
FORT SMITH AR
72903-4022
US

IV. Provider business mailing address

7001 ROGERS AVE STE 200
FORT SMITH AR
72903-4022
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number255845
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-12889
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: