Provider Demographics
NPI:1649501818
Name:SRIDEVI PAVULURI MD PA
Entity type:Organization
Organization Name:SRIDEVI PAVULURI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-534-9050
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-0529
Mailing Address - Country:US
Mailing Address - Phone:281-534-9050
Mailing Address - Fax:281-534-9030
Practice Address - Street 1:3828 HUGHES CT
Practice Address - Street 2:SUITE 201
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6244
Practice Address - Country:US
Practice Address - Phone:281-534-9050
Practice Address - Fax:281-534-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015TDOtherBSBSTX
TX212493501Medicaid
TX0A6132Medicare Oscar/Certification
TX0015TDOtherBSBSTX