Provider Demographics
NPI:1902907512
Name:VASUDEVA REDDY BOOSUPALLI MD PA
Entity Type:Organization
Organization Name:VASUDEVA REDDY BOOSUPALLI MD PA
Other - Org Name:BAY AREA CHILD NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASUDEVA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:BOOSUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-481-0002
Mailing Address - Street 1:131 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3203
Mailing Address - Country:US
Mailing Address - Phone:281-481-0002
Mailing Address - Fax:281-481-0007
Practice Address - Street 1:131 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3203
Practice Address - Country:US
Practice Address - Phone:281-481-0002
Practice Address - Fax:281-481-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM34752084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty