Provider Demographics
NPI:1548418130
Name:VIJAYALAKSHMI M TAMMAREDDI MD PA
Entity Type:Organization
Organization Name:VIJAYALAKSHMI M TAMMAREDDI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-2332
Mailing Address - Street 1:2965 HARRISON ST
Mailing Address - Street 2:SUITE # 316
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1100
Mailing Address - Country:US
Mailing Address - Phone:409-899-2332
Mailing Address - Fax:409-923-1998
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4584207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127518204Medicaid
TXC22459Medicare UPIN
TX127518204Medicaid