Provider Demographics
NPI:1497836944
Name:TAMMAREDDI, VIJAYALAKSHMI MADALA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYALAKSHMI
Middle Name:MADALA
Last Name:TAMMAREDDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4715 MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7712
Mailing Address - Country:US
Mailing Address - Phone:409-899-4212
Mailing Address - Fax:409-899-4212
Practice Address - Street 1:2965 HARRISON ST
Practice Address - Street 2:SUITE 316
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1100
Practice Address - Country:US
Practice Address - Phone:409-899-2332
Practice Address - Fax:409-923-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4584207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127518204Medicaid
TX127518204Medicaid
TXC22459Medicare UPIN