Provider Demographics
NPI:1942415930
Name:REDDY, SRILATHA ARREM (MD)
Entity Type:Individual
Prefix:
First Name:SRILATHA
Middle Name:ARREM
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 1:1302 LANE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2257
Mailing Address - Country:US
Mailing Address - Phone:972-870-0788
Mailing Address - Fax:972-870-0393
Practice Address - Street 1:1302 LANE ST
Practice Address - Street 2:STE 300
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2257
Practice Address - Country:US
Practice Address - Phone:972-870-0788
Practice Address - Fax:972-870-0393
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146831604Medicaid
TX0788QMedicare ID - Type Unspecified
TX146831604Medicaid