Provider Demographics
NPI:1790938363
Name:MALLIPEDDI, VISHWANTH REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHWANTH REDDY
Middle Name:
Last Name:MALLIPEDDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 DAUPHIN ST
Mailing Address - Street 2:BUILDING B, SUITE 118
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4060
Mailing Address - Country:US
Mailing Address - Phone:251-545-4579
Mailing Address - Fax:251-287-1466
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-545-4579
Practice Address - Fax:251-287-1466
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.33273207Q00000X
MN53619207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I937626Medicare PIN