1912162835 NPI NUMBER - DR. ASHADEEP CHANDRAREDDY, MD

NPI Number 1912162835 is assigned to an individual registered under the provider name DR. ASHADEEP CHANDRAREDDY, MD . The NPPES NPI record indicates the provider is a female.

The provider is physically located at:

800 WASHINGTON ST # 340 DIVISION OF CLINICAL GENETICS, TUFTS NEMC BOSTON, MA ZIP 02111 Phone: (617) 636-6098 Fax: (617) 636-0745

The enumeration date for this NPI number is 7/21/2008 and was last updated on 7/21/2008 .

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NPI Number 1912162835

Entity Type Code Individual

Provider Legal Name DR. ASHADEEP CHANDRAREDDY, MD

Provider Business Practice Location Address

800 WASHINGTON ST # 340 DIVISION OF CLINICAL GENETICS, TUFTS NEMC BOSTON, MA ZIP 02111

Practice Location Phone Number

(617) 636-6098

Provider Taxonomy Code 207SG0201X - Medical Genetics

Specialization Clinical Genetics (M.D.)

Provider Enumeration Date 7/21/2008

Last Update Date 7/21/2008

DETAILED INFORMATION

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The following information regarding the scope of practice of this provider is available:

The following legacy identifiers for this provider are available:

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This page was last updated on: 9/10/2012

TAXONOMY CODES

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License Number State

1 207SG0201X Medical Genetics Clinical Genetics (M.D.) 237825 MA View Code

OTHER (LEGACY) IDENTIFIERS

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer

NPI RECORD

No. Field Name Field Value

1 NPI 1912162835

2 Entity Type Code 1

3 Provider Last Name Legal Name CHANDRAREDDY

4 Provider First Name ASHADEEP

5 Provider Name Prefix Text DR.

6 Provider Credential Text MD

7 Provider First Line Business Practice Location Address 800 WASHINGTON ST # 340

8 Provider Second Line Business Practice Location Address DIVISION OF CLINICAL GENETICS, TUFTS NEMC

9 Provider Business Practice Location Address City Name BOSTON

10 Provider Business Practice Location Address State Name MA

11 Provider Business Practice Location Address Postal Code 02111

12 Provider Business Practice Location Address Country Code If outside U S US

13 Provider Business Practice Location Address Telephone Number 6176366098

14 Provider Business Practice Location Address Fax Number 6176360745

15 Provider Enumeration Date 7/21/2008

16 Last Update Date 7/21/2008

17 Provider Gender Code F

18 Healthcare Provider Taxonomy Code 1 207SG0201X

19 Provider License Number 1 237825

20 Provider License Number State Code 1 MA

21 Healthcare Provider Primary Taxonomy Switch 1 Y

22 Is Sole Proprietor Y

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