Provider Demographics
NPI:1144294711
Name:NARRA, SRIDHAR (MD)
Entity type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:NARRA
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 1:3708 JEFFERSON ST
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6206
Mailing Address - Country:US
Mailing Address - Phone:512-459-6503
Mailing Address - Fax:512-454-7453
Practice Address - Street 1:3708 JEFFERSON ST
Practice Address - Street 2:STE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6206
Practice Address - Country:US
Practice Address - Phone:512-459-6503
Practice Address - Fax:512-454-7453
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074999207R00000X
TXN1401208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI443744010Medicaid
5237621OtherLEGACY
MI5315009871OtherPHARMACY LIC
TXTXB155615OtherWELLMED NETWORKS INC
MI104437440Medicaid
TXB155615OtherWELLMED NETWORKS INC
TXB150302OtherWELLMED MEDICAL GROUP PA
MI443744010Medicaid
MI104437440Medicaid