Provider Demographics
NPI:1730102062
Name:REDDY, MALLADI S (MD, FACC, PA)
Entity Type:Individual
Prefix:
First Name:MALLADI
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD, FACC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 GARTH ROAD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-420-6000
Mailing Address - Fax:281-420-9000
Practice Address - Street 1:2398 BAYCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3702
Practice Address - Country:US
Practice Address - Phone:281-420-6000
Practice Address - Fax:281-420-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA24683Medicare UPIN