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General NPI Number Information
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NPI Number | 1508370701
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Entity Type | Organization
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Legal Business Name | PEDS CENTER OF ROUND ROCK PA
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 1526 LEANDER RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8801
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Country | US
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Telephone | 512-863-7586
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Fax | 512-863-5222
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Provider Business Mailing Address
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Address Line | 1526 LEANDER RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8801
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Country | US
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Telephone | 512-863-7586
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Fax | 512-863-5222
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Authorized Official
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Title or Position | OWNER
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Name | VIVEKANANDA DASARI
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Credential | M.D.
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Telephone | 201-289-7621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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