Provider Demographics
NPI:1255313466
Name:KAMIREDDI, MADHAVI (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:KAMIREDDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHAVI
Other - Middle Name:A
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:289 GREAT ROAD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-679-1200
Mailing Address - Fax:978-486-4037
Practice Address - Street 1:289 GREAT ROAD
Practice Address - Street 2:SUITE G1
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-679-1200
Practice Address - Fax:978-486-4037
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223251101Y00000X, 101YM0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043476807-17OtherPACIFICARE
MA363646OtherMHN
MA494182OtherTUFTS
MA2105462Medicaid
NH01Y008389MA01OtherBCBSNH
MA967628OtherNETWORK HEALTH
MAJ28990OtherBCBSMA
MA800708000OtherMAGELLAN
MA800708000OtherMAGELLAN
MAA38272Medicare ID - Type Unspecified