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General NPI Number Information
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NPI Number | 1134127624
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Entity Type | Individual
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Provider Name | GURIJALA N REDDY MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 6 FIELDCREST AVE
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City | WHEELING
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State | WV
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Zip | 26003-5645
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Country | US
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Telephone | 304-281-7928
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Fax |
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Provider Business Mailing Address
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Address Line | 6 FIELDCREST AVE
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City | WHEELING
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State | WV
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Zip | 26003-5645
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Country | US
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Telephone | 304-281-7928
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 35045719
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 12217
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License Number State | WV
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