Basic Information
| Provider Information | |||||||||
| NPI: | 1568776540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUPPIREDDY | ||||||||
| FirstName: | PALLAVI REDDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRESHAM DR FL 5 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573883198 | ||||||||
| FaxNumber: | 7573884242 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRESHAM DR FL 5 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573883198 | ||||||||
| FaxNumber: | 7573884242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2010 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101253180 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101253180 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10109990 | 01 | VA | OPTIMA HEALTH | OTHER | 1568776540 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1568776540 | 05 | VA | MEDICAID | 1568776540 | 05 | NC | MEDICAID | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 494178 | 01 | VA | ANTHEM BC/BS | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | AETNA | OTHER | -028 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1568776540 | 01 | VA | COVENTRY NETWORK | OTHER | 1568776540 | 01 | VA | UNITED HEALTHCARE | OTHER | PAR | 01 | VA | CORVEL | OTHER |