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
1	208000000X	Pediatrics Physician	L0190	TX
2	207L00000X	Anesthesiology Physician	L0190	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID 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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