Basic Information
Provider Information | |||||||||
NPI: | 1871016832 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANANT | ||||||||
FirstName: | KEDAARI | ||||||||
MiddleName: | REDDY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REDDY | ||||||||
OtherFirstName: | KEDAARI | ||||||||
OtherMiddleName: | ANANT | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 454 OLD STREET RD STE 301 | ||||||||
Address2: |   | ||||||||
City: | PETERBOROUGH | ||||||||
State: | NH | ||||||||
PostalCode: | 034581200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6039244680 | ||||||||
FaxNumber: | 6039244977 | ||||||||
Practice Location | |||||||||
Address1: | 454 OLD STREET RD STE 301 | ||||||||
Address2: |   | ||||||||
City: | PETERBOROUGH | ||||||||
State: | NH | ||||||||
PostalCode: | 034581200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6039244680 | ||||||||
FaxNumber: | 6039244977 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2017 | ||||||||
LastUpdateDate: | 06/14/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 22283 | NH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 22283 | NH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.