Provider Demographics
NPI:1508986373
Name:MALLADI & REDDY, PA
Entity Type:Organization
Organization Name:MALLADI & REDDY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BHAGVAN
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:MALLADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:936-634-8136
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:936-634-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty