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General NPI Number Information
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NPI Number | 1639250392
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Entity Type | Individual
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Provider Name | PADMAVATHAMMA POTHALA MD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 1009 E 40TH STREET SUITE 300B
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City | AUSTIN
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State | TX
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Zip | 78751-4812
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Country | US
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Telephone | 512-482-8280
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Fax | 512-482-9457
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Provider Business Mailing Address
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Address Line | PO BOX 200009
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City | AUSTIN
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State | TX
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Zip | 78720-0009
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Country | US
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Telephone | 512-482-8280
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Fax | 512-482-9457
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L0909
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License Number State | TX
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