Healthcare Provider Details

I. General information

NPI: 1750578779
Provider Name (Legal Business Name): USHA GUJJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY BLDG B #220
CEDAR PARK TX
78613-7464
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-4083
  • Fax: 512-324-4717
Mailing address:
  • Phone: 512-407-8686
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35089386
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM8690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: