1255313466 NPI number — MADHAVI KAMIREDDI M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255313466 NPI number — MADHAVI KAMIREDDI M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KAMIREDDI

Provider First Name:

MADHAVI

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

REDDY

Provider Other First Name:

MADHAVI

Provider Other Middle Name:

A

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

1

NPI Number:

1255313466

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/09/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

289 GREAT ROAD

Provider Second Line Business Mailing Address:

SUITE G1

Provider Business Mailing Address City Name:

ACTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01720

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-679-1200

Provider Business Mailing Address Fax Number:

978-486-4037

Provider First Line Business Practice Location Address:

289 GREAT ROAD

Provider Second Line Business Practice Location Address:

SUITE G1

Provider Business Practice Location Address City Name:

ACTON

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01720

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-679-1200

Provider Business Practice Location Address Fax Number:

978-486-4037

Provider Enumeration Date:

11/15/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101Y00000X , with the licence number:  223251 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YM0800X , with the licence number: 223251 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084P0800X , with the licence number: 223251 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 043476807-17 . This is a "PACIFICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 363646 . This is a "MHN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 494182 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 2105462 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 01Y008389MA01 . This is a "BCBSNH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: 967628 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: J28990 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 800708000 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".