Healthcare Provider Details

I. General information

NPI: 1346598943
Provider Name (Legal Business Name): VENKATA SUBBA REDDY VAJRALA M. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST STE SE3100B
DAYTON OH
45409-2722
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8394
  • Fax: 937-641-2780
Mailing address:
  • Phone: 937-991-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.126134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: