Healthcare Provider Details

I. General information

NPI: 1336643907
Provider Name (Legal Business Name): PRANAY RYAN REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 GATEWAY BLVD
NEWBURGH IN
47630-7925
US

IV. Provider business mailing address

PO BOX 631767
CINCINNATI OH
45263-1767
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9545
  • Fax:
Mailing address:
  • Phone: 812-450-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01100971A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: