Provider Demographics
NPI:1598253239
Name:TAFAJ REDDY, OLTA (MD)
Entity type:Individual
Prefix:
First Name:OLTA
Middle Name:
Last Name:TAFAJ REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLTA
Other - Middle Name:
Other - Last Name:TAFAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 MOUNT AUBURN ST # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:SOUTH 4 ROOM 454
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5597
Practice Address - Country:US
Practice Address - Phone:617-499-5112
Practice Address - Fax:617-575-8608
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA289738208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist