Healthcare Provider Details

I. General information

NPI: 1801139233
Provider Name (Legal Business Name): VIJAY SRIRAJ MADHURAPANTULA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2774 E ELDORADO PKWY STE 100
LITTLE ELM TX
75068-5998
US

IV. Provider business mailing address

PO BOX 360541
PITTSBURGH PA
15251-6541
US

V. Phone/Fax

Practice location:
  • Phone: 972-525-9900
  • Fax: 469-333-7988
Mailing address:
  • Phone: 972-525-9900
  • Fax: 469-333-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS7715
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD458403
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT205248
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: