Provider Demographics
NPI:1770595571
Name:REDDY, RAMA T (MD)
Entity type:Individual
Prefix:DR
First Name:RAMA
Middle Name:T
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMA
Other - Middle Name:T
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2140 KINGSLEY AVE.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-529-5252
Mailing Address - Fax:904-529-5253
Practice Address - Street 1:2140 KINGSLEY AVE.
Practice Address - Street 2:SUITE 10
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-529-5252
Practice Address - Fax:904-529-5253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93749207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54259OtherBCBS
FL54259OtherBCBS