MEDICARE: VISHNUVARDHAN REDDY KOMARI 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	390200000X	Student in an Organized Health Care Education/Training Program	57-015853	OH
2	207R00000X	Internal Medicine Physician	C147294	CA

General Provider Information

NPI Number	:	1790929966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHNUVARDHAN REDDY KOMARI M.D.

Provider Business Mailing Address
First Line	:	3913 PURPLE FINCH LN
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-8515
Country	:	US
Telephone Number	:	832-472-8576
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213
Country	:	US
Telephone Number	:	614-243-7535
Fax Number	:

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

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	07/21/2022

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