MEDICARE: DR. KAVITHA D 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	207Q00000X	Family Medicine Physician	202767	NY

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	:	1811983612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVITHA D REDDY MD

Provider Business Mailing Address
First Line	:	7218 164TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-4222
Country	:	US
Telephone Number	:	718-969-6640
Fax Number	:	718-969-1050

Provider Business Practice Location Address
First Line	:	7218 164TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-4222
Country	:	US
Telephone Number	:	718-969-6640
Fax Number	:	718-969-1050

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	10/12/2011

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