Provider Demographics
NPI:1225131543
Name:REDDY, MAHATHI ADLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHATHI
Middle Name:ADLA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAHATHI
Other - Middle Name:REDDY
Other - Last Name:ADLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14134 NEPHRON LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6504
Mailing Address - Country:US
Mailing Address - Phone:727-863-5418
Mailing Address - Fax:727-497-0028
Practice Address - Street 1:14134 NEPHRON LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6504
Practice Address - Country:US
Practice Address - Phone:727-863-5418
Practice Address - Fax:727-497-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429925207R00000X
FLME104435207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine