Provider Demographics
NPI:1487754693
Name:REDDY, LALITHA M (MD)
Entity type:Individual
Prefix:
First Name:LALITHA
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAV
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:9413 FLATLANDS AVENUE
Mailing Address - Street 2:SUITE 101 WEST
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3726
Mailing Address - Country:US
Mailing Address - Phone:718-257-6615
Mailing Address - Fax:718-272-3365
Practice Address - Street 1:9413 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3726
Practice Address - Country:US
Practice Address - Phone:718-257-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1514601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0076753Medicaid
NY0076753Medicaid
B79591Medicare UPIN