Provider Demographics
NPI:1184635344
Name:MALLEPALLI, JYOTHI REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:REDDY
Last Name:MALLEPALLI
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:PO BOX 4083
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-4083
Mailing Address - Country:US
Mailing Address - Phone:318-388-5830
Mailing Address - Fax:318-322-1249
Practice Address - Street 1:3402 MAGNOLIA COVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-388-5830
Practice Address - Fax:318-322-1249
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12442R207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1533424Medicaid
LA5A063Medicare ID - Type Unspecified
LAG17856Medicare UPIN