Healthcare Provider Details

I. General information

NPI: 1891257283
Provider Name (Legal Business Name): NAMRATA REDDY JANNAREDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4318
US

IV. Provider business mailing address

6701 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4318
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6200
  • Fax:
Mailing address:
  • Phone: 505-727-6200
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD2024-0378
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: