Healthcare Provider Details

I. General information

NPI: 1740340249
Provider Name (Legal Business Name): SUDHEER CHINTHAKUNT REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 THOMAS JOHNSON DR
FREDERICK MD
21702-4501
US

IV. Provider business mailing address

52 THOMAS JOHNSON DR
FREDERICK MD
21702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-9573
  • Fax:
Mailing address:
  • Phone: 301-663-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0069710
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA102637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: