Provider Demographics
NPI:1831268408
Name:MARRI, LAXMA REDDY (MD)
Entity type:Individual
Prefix:MR
First Name:LAXMA
Middle Name:REDDY
Last Name:MARRI
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 1:3606 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5543
Mailing Address - Country:US
Mailing Address - Phone:812-234-6977
Mailing Address - Fax:812-234-7186
Practice Address - Street 1:3606 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5543
Practice Address - Country:US
Practice Address - Phone:812-234-6977
Practice Address - Fax:812-234-7186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041697A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100375850AMedicaid
INF05655Medicare UPIN
IN100375850AMedicaid