MEDICARE: METRO GERIATRIC SERVICES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1174870026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO GERIATRIC SERVICES PA

Provider Business Mailing Address
First Line	:	2804 FOX CREEK TRL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-7960
Country	:	US
Telephone Number	:	817-659-5395
Fax Number	:	817-439-6767

Provider Business Practice Location Address
First Line	:	2804 FOX CREEK TRL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-7960
Country	:	US
Telephone Number	:	817-659-5395
Fax Number	:	817-439-6767

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIJAYA SUDANAGUNTA
Credential	:	M.D.
Telephone Number	:	817-659-5393

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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Directions to “METRO GERIATRIC SERVICES PA ” Practice Location

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