=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982690996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDIRA M. REDDY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2005
-----------------------------------------------------
Last Update Date | 03/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 NEW WAVERLY PL SUITE 314
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27518-7414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-858-0892
-----------------------------------------------------
Fax | 919-342-3472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 18563
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27619-8563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-783-4888
-----------------------------------------------------
Fax | 919-783-4887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 2004-00402
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------