Individual
VIJAYRAM REDDY MALLADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260-2813
(917) 678-6062
Mailing address
1600 N MAIN AVE, LOVINGTON, NM 88260-2813
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
94-09597
KS
207R00000X
Internal Medicine Physician
Primary
MD2023-1019
NM
Other
Enumeration date
06/12/2018
Last updated
08/14/2023
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