Healthcare Provider Details

I. General information

NPI: 1487955274
Provider Name (Legal Business Name): RAVINDRA R REDDY MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 GENERAL DEGAULLE DR SUITE 4098
NEW ORLEANS LA
70114-6757
US

IV. Provider business mailing address

3520 GENERAL DEGAULLE DR SUITE 4098
NEW ORLEANS LA
70114-6757
US

V. Phone/Fax

Practice location:
  • Phone: 504-362-8046
  • Fax: 504-362-2215
Mailing address:
  • Phone: 504-362-8046
  • Fax: 504-362-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number15088R
License Number StateLA

VIII. Authorized Official

Name: RAVINDRA R REDDY
Title or Position: DIRECTOR
Credential: M.D.
Phone: 504-362-8046