Provider Demographics
NPI:1447259700
Name:REDDY, NALINI P (MD)
Entity type:Individual
Prefix:
First Name:NALINI
Middle Name:P
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NALINI
Other - Middle Name:
Other - Last Name:GOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9460 BELLA TERRA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-1902
Mailing Address - Country:US
Mailing Address - Phone:817-244-5685
Mailing Address - Fax:817-244-5685
Practice Address - Street 1:9460 BELLA TERRA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-1902
Practice Address - Country:US
Practice Address - Phone:817-244-5685
Practice Address - Fax:817-244-5685
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL37962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146552801Medicaid
TX8D1205Medicare ID - Type Unspecified
TX146552801Medicaid