MEDICARE: MALLADI S REDDY M.D., FACC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	J3885	TX

General Provider Information

NPI Number	:	1730102062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLADI S REDDY M.D., FACC, PA

Provider Business Mailing Address
First Line	:	4201 GARTH ROAD
Second Line	:	SUITE 315
City	:	BAYTOWN
State	:	TX
Zip	:	77521
Country	:	US
Telephone Number	:	281-420-6000
Fax Number	:	281-420-9000

Provider Business Practice Location Address
First Line	:	2398 BAYCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3702
Country	:	US
Telephone Number	:	281-420-6000
Fax Number	:	281-420-9000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/16/2015

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