Healthcare Provider Details

I. General information

NPI: 1235573296
Provider Name (Legal Business Name): DEEPAK REDDY VATTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 KINSLEY ST
NASHUA NH
03060-3648
US

IV. Provider business mailing address

172 KINSLEY ST
NASHUA NH
03060-3648
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-3000
  • Fax:
Mailing address:
  • Phone: 603-882-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17538
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: