Individual
DR. PRAMOD A REDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 MOONBOW PLZ, CORBIN, KY 40701-8949
(606) 523-9010
(606) 523-5923
Mailing address
PO BOX 1325, CORBIN, KY 40702-1325
(606) 526-8131
(606) 528-8661
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
29557
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64295579
—
KY
01
—
K000751
MEDICARE PTAN
KY
01
—
P01427298
RR MEDICARE
KY
Enumeration date
06/16/2005
Last updated
12/08/2020
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