Provider Demographics
NPI:1063605756
Name:REDDY, VEDIRE V (MD)
Entity type:Individual
Prefix:DR
First Name:VEDIRE
Middle Name:V
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1319 SUNSET DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3799
Mailing Address - Country:US
Mailing Address - Phone:423-926-6266
Mailing Address - Fax:423-926-7599
Practice Address - Street 1:100 15TH ST NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1616
Practice Address - Country:US
Practice Address - Phone:276-679-8890
Practice Address - Fax:276-679-9740
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2010-04-20
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Provider Licenses
StateLicense IDTaxonomies
VA0101245329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063605756Medicaid