Provider Demographics
NPI:1730610320
Name:RADHA TAMERISA MD PA
Entity type:Organization
Organization Name:RADHA TAMERISA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAMERISA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-395-8688
Mailing Address - Street 1:1331 W GRAND PKWY N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2710
Mailing Address - Country:US
Mailing Address - Phone:281-395-8688
Mailing Address - Fax:281-395-8480
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:SUITE 350
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:281-395-8688
Practice Address - Fax:281-395-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7210207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty