Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0401416692 | VA |
NPI | 1114578192 |
---|---|
Provider Name | Dr. Keerthi Reddy Kamreddy |
First Address | Ashburn, VA 20148-7350 |
Second Address | Mechanicsville, VA 23116-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2019 |
Last Update Date | 22/09/2019 |