MEDICARE: NAVEEN KUMAR REDDY AMBATI

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	207W00000X	Ophthalmology Physician	0101288603	VA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922749829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVEEN KUMAR REDDY AMBATI

Provider Business Mailing Address
First Line	:	234 GOODMAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2364
Country	:	US
Telephone Number	:	513-584-4505
Fax Number	:	513-584-0468

Provider Business Practice Location Address
First Line	:	234 GOODMAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2364
Country	:	US
Telephone Number	:	513-584-4505
Fax Number	:	513-584-0468

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	06/01/2026

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