Provider Demographics
NPI:1386747236
Name:MALLADI, BHAGWAN REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:BHAGWAN
Middle Name:REDDY
Last Name:MALLADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-7906
Mailing Address - Country:US
Mailing Address - Phone:765-935-6730
Mailing Address - Fax:
Practice Address - Street 1:498 N.W. 18TH STREET
Practice Address - Street 2:RICHMOND STATE HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2898
Practice Address - Country:US
Practice Address - Phone:765-966-0511
Practice Address - Fax:765-935-9512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010461792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry