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General NPI Number Information
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NPI Number | 1881904316
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Entity Type | Organization
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Legal Business Name | VENKATA S. ERELLA, MD PA
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 11851 JOLLYVILLE RD STE 104
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City | AUSTIN
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State | TX
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Zip | 78759-2350
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Country | US
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Telephone | 512-257-2425
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Fax | 512-257-2426
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Provider Business Mailing Address
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Address Line | PO BOX 201450
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City | AUSTIN
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State | TX
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Zip | 78720-1450
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Country | US
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Telephone | 512-257-2425
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Fax | 512-257-2426
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Authorized Official
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Title or Position | OWNER/RENDERING PROVIDER
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Name | DR. VENKATA S ERELLA
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Credential | M.D.
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Telephone | 512-257-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | TX
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