Provider Demographics
NPI:1174566590
Name:REDDY, VEENA KOMMERA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:KOMMERA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2469
Mailing Address - Country:US
Mailing Address - Phone:361-500-4351
Mailing Address - Fax:888-711-1008
Practice Address - Street 1:4254 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2469
Practice Address - Country:US
Practice Address - Phone:361-500-4351
Practice Address - Fax:888-711-1008
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2455208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159697501Medicaid
TXI52184Medicare UPIN
TX00505UMedicare ID - Type Unspecified