Provider Demographics
NPI:1689695538
Name:MANDADI, PRANATHI REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:PRANATHI
Middle Name:REDDY
Last Name:MANDADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:166 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6619
Practice Address - Country:US
Practice Address - Phone:732-229-2020
Practice Address - Fax:732-229-2255
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MAO7965000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine