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NPI Code Detail

MEDICARE: MEERA GANGADHARAN M.D.

MEDICARE: MEERA GANGADHARAN M.D.
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
1208000000XPediatrics PhysicianL0190TX
2207L00000XAnesthesiology PhysicianL0190TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558363671
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEERA GANGADHARAN M.D.
Provider Business Mailing Address
First Line : 3533 S ALAMEDA ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78411-1721
Country : US
Telephone Number : 361-694-5445
Fax Number : 361-694-5449
Provider Business Practice Location Address
First Line : 3533 S ALAMEDA ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78411-1721
Country : US
Telephone Number : 361-694-5445
Fax Number : 361-694-5449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 05/27/2010

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