{
"Npi": {
"NPI": "1215134630",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MALLAREDDY",
"FirstName": "MADHAVI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2811 DUKE OF GLOUCESTER ST",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "DESOTO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75115-2017",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-274-5555",
"MailingAddressFaxNumber": "972-274-5663",
"FirstLinePracticeLocationAddress": "2698 N GALLOWAY AVE",
"SecondLinePracticeLocationAddress": "SUITE 104",
"PracticeLocationAddressCityName": "MESQUITE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75150-6383",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-681-4444",
"PracticeLocationAddressFaxNumber": "214-635-3868",
"EnumerationDate": "06/29/2007",
"LastUpdateDate": "03/15/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "N3859",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}