| Sudesh S Reddy MD Inc | |
|
402 S State St Marion OH 43302-5000 | |
| (740) 387-0650 | |
| (740) 387-9210 |
| Full Name | Sudesh S Reddy MD Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 402 S State St, Marion, Ohio |
| Authorized Official Name and Position | Sudesh Reddy (OWNER) |
| Authorized Official Contact | 7403870650 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sudesh S Reddy MD Inc 402 S State St Marion OH 43302-5000 Ph: (740) 387-0650 | Sudesh S Reddy MD Inc 402 S State St Marion OH 43302-5000 Ph: (740) 387-0650 |
| NPI Number | 1578540910 |
|---|---|
| Provider Enumeration Date | 12/28/2005 |
| Last Update Date | 05/30/2013 |
| Medicare PECOS PAC ID | 1153389564 |
|---|---|
| Medicare Enrollment ID | O20041230000426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578540910 | NPI | - | NPPES |
| 2550707 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 208000000X | Pediatrics | () | Secondary |
| Provider Name | Sudesh Sandadi Reddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104015775 PECOS PAC ID: 3072571488 Enrollment ID: I20041230000416 |
| Provider Name | Jane I Wolfe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912975293 PECOS PAC ID: 9032136932 Enrollment ID: I20051031000315 |
| Provider Name | Sheila S Reddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457648636 PECOS PAC ID: 7911133475 Enrollment ID: I20170228000878 |
| Provider Name | Kelley Marie Mamede |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003456286 PECOS PAC ID: 1254769656 Enrollment ID: I20210816001839 |
| Provider Name | Karen Pauley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003079328 PECOS PAC ID: 1052564085 Enrollment ID: I20220506002035 |
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