Provider Demographics
NPI:1548487572
Name:MALLADI S REDDY, MD, FACC, PA
Entity type:Organization
Organization Name:MALLADI S REDDY, MD, FACC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:MALLADI
Authorized Official - Middle Name:S
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-420-6000
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3167
Mailing Address - Country:US
Mailing Address - Phone:281-420-6000
Mailing Address - Fax:281-420-9000
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:SUITE 315
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-420-6000
Practice Address - Fax:281-420-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3885261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center