Provider Demographics
NPI:1174534960
Name:REDDY, SATYA VARDHAN (MD)
Entity type:Individual
Prefix:DR
First Name:SATYA
Middle Name:VARDHAN
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7512
Mailing Address - Country:US
Mailing Address - Phone:985-893-8290
Mailing Address - Fax:985-893-8291
Practice Address - Street 1:128 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7512
Practice Address - Country:US
Practice Address - Phone:985-893-8290
Practice Address - Fax:985-893-8291
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114434207W00000X
LA025136207W00000X, 207WX0120X
KY40519207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I44566Medicare UPIN
KY1360105Medicare PIN