=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063490803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C G REDDY MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2006
-----------------------------------------------------
Last Update Date | 10/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1973 EAST MAIN STREET
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-9353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-653-9476
-----------------------------------------------------
Fax | 740-653-9478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1973 EAST MAIN STREET
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-9353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-653-9476
-----------------------------------------------------
Fax | 740-653-9478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. GURU REDDY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 740-653-9476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 35041941
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------