Provider Demographics
NPI:1871706192
Name:DR. AJAY REDDY, L.L.C.
Entity type:Organization
Organization Name:DR. AJAY REDDY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-230-9091
Mailing Address - Street 1:3200 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE#110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4216
Mailing Address - Country:US
Mailing Address - Phone:301-230-9091
Mailing Address - Fax:301-230-9091
Practice Address - Street 1:3200 TOWER OAKS BLVD
Practice Address - Street 2:SUITE#110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4216
Practice Address - Country:US
Practice Address - Phone:301-230-9091
Practice Address - Fax:301-230-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023103700Medicaid
MDG01268Medicare ID - Type Unspecified
MDG15326Medicare UPIN
MD023103700Medicaid