Provider Demographics
NPI:1144454026
Name:MARUVADA, SREEKAR (MD)
Entity type:Individual
Prefix:MR
First Name:SREEKAR
Middle Name:
Last Name:MARUVADA
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 1:210 LAKE RD STE 800B
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-299-6400
Mailing Address - Fax:979-299-6401
Practice Address - Street 1:210 LAKE RD STE 800B
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-299-6400
Practice Address - Fax:979-299-6401
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203105601Medicaid
TX203105602OtherTHSTEPS