MEDICARE: SUCHITA REDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E3754	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154325132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUCHITA REDDY M.D.

Provider Business Mailing Address
First Line	:	2919 MARKUM DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117
Country	:	US
Telephone Number	:	817-831-0321
Fax Number	:	817-831-3211

Provider Business Practice Location Address
First Line	:	2919 MARKUM DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117
Country	:	US
Telephone Number	:	817-831-0321
Fax Number	:	817-831-3211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2010

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Directions to “ SUCHITA REDDY M.D.” Practice Location

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