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General NPI Number Information
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NPI Number | 1245263524
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Entity Type | Individual
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Provider Name | SURENDER REDDY EDLA MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 1790 OLD TRAIL RD
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City | ETTERS
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State | PA
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Zip | 17319-9652
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Country | US
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Telephone | 717-938-6588
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Fax | 717-938-9601
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Provider Business Mailing Address
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Address Line | 6020 RICHMOND HWY STE 102
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City | ALEXANDRIA
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State | VA
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Zip | 22303-2157
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Country | US
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Telephone | 443-363-3953
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101239065
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD429426
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License Number State | PA
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