Healthcare Provider Details

I. General information

NPI: 1881904316
Provider Name (Legal Business Name): VENKATA S. ERELLA, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 JOLLYVILLE RD STE 104
AUSTIN TX
78759-2350
US

IV. Provider business mailing address

PO BOX 201450
AUSTIN TX
78720-1450
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-2425
  • Fax: 512-257-2426
Mailing address:
  • Phone: 512-257-2425
  • Fax: 512-257-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. VENKATA S ERELLA
Title or Position: OWNER/RENDERING PROVIDER
Credential: M.D.
Phone: 512-257-2425