1447259700 NPI number — NALINI P REDDY MD

Table of content: NALINI P REDDY MD (NPI 1447259700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447259700 NPI number — NALINI P REDDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
NALINI
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLI
Provider Other First Name:
NALINI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447259700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9460 BELLA TERRA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76126-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-244-5685
Provider Business Mailing Address Fax Number:
817-244-5685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9460 BELLA TERRA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76126-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-244-5685
Provider Business Practice Location Address Fax Number:
817-244-5685
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  L3796 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 146552801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112371100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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