Provider Demographics
NPI:1053798298
Name:REDDY, KARISHMA (MD)
Entity type:Individual
Prefix:
First Name:KARISHMA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11934 W BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1100
Mailing Address - Country:US
Mailing Address - Phone:804-423-2100
Mailing Address - Fax:804-716-5057
Practice Address - Street 1:11934 W BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1100
Practice Address - Country:US
Practice Address - Phone:804-423-2100
Practice Address - Fax:804-716-5057
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210210390200000X
VA01012712412086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program