Provider Demographics
NPI:1164525440
Name:SRILATHA A. REDDY, M.D., P.A
Entity Type:Organization
Organization Name:SRILATHA A. REDDY, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRILATHA
Authorized Official - Middle Name:ARREM
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-342-4277
Mailing Address - Street 1:1302 LANE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2257
Mailing Address - Country:US
Mailing Address - Phone:972-870-0788
Mailing Address - Fax:972-870-0393
Practice Address - Street 1:1302 LANE ST
Practice Address - Street 2:STE 300
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2257
Practice Address - Country:US
Practice Address - Phone:972-870-0788
Practice Address - Fax:972-870-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146831601Medicaid
TX146831601Medicaid