Basic Information
| Provider Information | |||||||||
| NPI: | 1871576397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | ROOPA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MEETING HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782565522 | ||||||||
| FaxNumber: | 9782565399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEETING HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782565522 | ||||||||
| FaxNumber: | 9782565399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 77780 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110192287 | 01 | MA | MEDICARE RR NUMBER | OTHER | 3116204 | 05 | MA | MEDICAID |