MEDICARE: MANORAMA M 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	207RX0202X	Medical Oncology Physician	A39669	CA

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	:	1356341168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANORAMA M REDDY M.D.

Provider Business Mailing Address
First Line	:	4533 COLLEGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4010
Country	:	US
Telephone Number	:	619-583-8700
Fax Number	:	619-583-5866

Provider Business Practice Location Address
First Line	:	4533 COLLEGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4010
Country	:	US
Telephone Number	:	619-583-8700
Fax Number	:	619-583-5866

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/08/2011

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