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General NPI Number Information
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NPI Number | 1174870026
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Entity Type | Organization
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Legal Business Name | METRO GERIATRIC SERVICES PA
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 2804 FOX CREEK TRL
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City | ARLINGTON
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State | TX
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Zip | 76017-7960
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Country | US
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Telephone | 817-659-5395
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Fax | 817-439-6767
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Provider Business Mailing Address
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Address Line | 2804 FOX CREEK TRL
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City | ARLINGTON
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State | TX
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Zip | 76017-7960
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Country | US
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Telephone | 817-659-5395
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Fax | 817-439-6767
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIJAYA SUDANAGUNTA
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Credential | M.D.
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Telephone | 817-659-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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