MEDICARE: DR. PADMA VENUAOPALA REDDY MD

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	207RN0300X	Nephrology Physician	ME0053251	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	07032	OTHER	BC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215029400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PADMA VENUAOPALA REDDY MD

Provider Business Mailing Address
First Line	:	7415 W GULF TO LAKE HWY
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429
Country	:	US
Telephone Number	:	352-795-1415
Fax Number	:	352-795-6801

Provider Business Practice Location Address
First Line	:	7415 W GULF TO LAKE HWY
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429
Country	:	US
Telephone Number	:	352-795-1415
Fax Number	:	352-795-6801

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/06/2012

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Directions to “ DR. PADMA VENUAOPALA REDDY MD” Practice Location

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