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NPI Code Detail

MEDICARE: PAVANAJA REDDY M.D.

MEDICARE: PAVANAJA 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
1207L00000XAnesthesiology Physician206427NY
2207L00000XAnesthesiology PhysicianME141843FL

Other Identifiers

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

General Provider Information

NPI Number : 1235135989
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAVANAJA REDDY M.D.
Provider Business Mailing Address
First Line : 1600 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-3065
Country : US
Telephone Number : 863-680-7000
Fax Number :
Provider Business Practice Location Address
First Line : 1600 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-3065
Country : US
Telephone Number : 863-680-7000
Fax Number : 866-264-8519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 10/05/2022

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

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