Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 200000945 | NC |
NPI | 1013996651 |
---|---|
Provider Name | Dr. Vijaya Kumar Konda Reddy |
First Address | Durham, NC 27713-4430 |
Second Address | Durham, NC 27705-3941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 19/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135TG | BCBS (01) | NC |
89135TG | (05) | NC |
G79866 | (02) |