=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043403421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAIVEER T. REDDY, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2007
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 BARNETT ST
-----------------------------------------------------
City | BROOKVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15825-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-849-8858
-----------------------------------------------------
Fax | 814-849-3471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 BARNETT ST
-----------------------------------------------------
City | BROOKVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15825-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-849-8858
-----------------------------------------------------
Fax | 814-849-3471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAIVEER T. REDDY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 814-849-8858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------