Provider Demographics
NPI:1053949172
Name:NAGIREDDY, RADHA TARA (MD)
Entity type:Individual
Prefix:
First Name:RADHA
Middle Name:TARA
Last Name:NAGIREDDY
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 1:101 SCHILLING RD STE 40B
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1137
Mailing Address - Country:US
Mailing Address - Phone:410-753-8650
Mailing Address - Fax:
Practice Address - Street 1:101 SCHILLING RD STE 40B
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1137
Practice Address - Country:US
Practice Address - Phone:410-753-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01013182084P0800X
KS94-10350390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry