Basic Information
| Provider Information | |||||||||
| NPI: | 1609077841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | USHA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10305 HAMPTONS PARK DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953600 | ||||||||
| FaxNumber: | 7048923181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 2009-00215 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P01352651 | 01 | NC | RAILROAD MEDICARE | OTHER | Q1500 | 05 | SC | MEDICAID | 1470784 | 01 | WELLPATH | OTHER | Q15000 | 05 | SC | MEDICAID | 1528X | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | NC8506B | 01 | NC | MEDICARE | OTHER | 1053561 | 01 | SC | WELLCARE OF SC | OTHER | 30179939 | 01 | SC | SELECT HEALTH | OTHER | 3385593 | 01 | NC | CIGNA | OTHER |