Individual
DR. BHAGYAM CHENNA REDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
301 SULLIVAN WAY, WEST TRENTON, NJ 08628-3406
(609) 633-1500
Mailing address
301 SULLIVAN WAY, WEST TRENTON, NJ 08628-3406
(609) 633-1500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA05062500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
716738C2D
MEDICARE PROVIDER NUMBER
NJ
Enumeration date
09/27/2006
Last updated
12/22/2010
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