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General NPI Number Information
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NPI Number | 1558426445
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Entity Type | Individual
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Provider Name | PALUKURI BHARATH KUMAR REDDY MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 645 N 12TH STREET MHM CORRECTIONAL SERVICES, INC
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City | LEMOYNE
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State | PA
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Zip | 17053
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Country | US
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Telephone | 717-761-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 WATERFORD
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City | CAMP HILL
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State | PA
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Zip | 17011-1229
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Country | US
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Telephone | 717-965-3220
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 240109
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD431107
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License Number State | PA
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