Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 278817 | MA |
N | 207QA0505X | Family Doctor - Adult Medicine | MD19248 | ME |
NPI | 1144450891 |
---|---|
Provider Name | Shashidhar Reddy Madireddy |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 28/10/2020 |