Healthcare Provider Details

I. General information

NPI: 1396448114
Provider Name (Legal Business Name): SAMEER VIJAY HANUMAN REDDY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VIJAY REDDY

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 ROLLING RIDGE DR
STATE COLLEGE PA
16801-7639
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 814-689-4980
  • Fax: 814-689-4990
Mailing address:
  • Phone: 717-531-5208
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS026063
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: