Provider Demographics
NPI:1497010276
Name:MALLADI AND REDDY P.A.
Entity Type:Organization
Organization Name:MALLADI AND REDDY P.A.
Other - Org Name:ANESTHESIA AT MALLADI AND REDDY P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHUVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-3713
Mailing Address - Street 1:319 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3124
Mailing Address - Country:US
Mailing Address - Phone:936-634-3713
Mailing Address - Fax:
Practice Address - Street 1:319 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3124
Practice Address - Country:US
Practice Address - Phone:936-634-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty