Provider Demographics
NPI:1033620372
Name:CONGENIAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CONGENIAL HEALTHCARE, LLC
Other - Org Name:PRATHIMA V REDDY, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATHIMA
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-246-9131
Mailing Address - Street 1:1 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1209
Mailing Address - Country:US
Mailing Address - Phone:781-246-9131
Mailing Address - Fax:
Practice Address - Street 1:1 WALTON ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1209
Practice Address - Country:US
Practice Address - Phone:781-246-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGENIAL HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty