Provider Demographics
NPI:1669447298
Name:REDDY, PRATHIMA VEMURU (MD)
Entity Type:Individual
Prefix:
First Name:PRATHIMA
Middle Name:VEMURU
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1512
Mailing Address - Country:US
Mailing Address - Phone:978-561-1732
Mailing Address - Fax:
Practice Address - Street 1:1 WALTON STREET
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-246-9131
Practice Address - Fax:781-246-9159
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA071487OtherTUFTS
MA65035OtherHARVARD PILGRIM
MA3054420Medicaid
MAJ09157OtherBC/BS
MA73308OtherAFFORDABLE NETWORKS
MA0401419OtherUNITED HEALTHCARE
MA587634OtherAETNA
MAB10071201OtherCIGNA
MAF17179Medicare UPIN