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1053303958

NPI Code Detail

MEDICARE: POLLACHI P SELVAKUMARRAJ MD

MEDICARE: POLLACHI P SELVAKUMARRAJ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L1195	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L1195	OTHER	TX	PHYSICIAN PERMIT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053303958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POLLACHI P SELVAKUMARRAJ MD

Provider Business Mailing Address
First Line	:	2800 S TEXAS AVE
Second Line	:	STE 202
City	:	BRYAN
State	:	TX
Zip	:	77802-5361
Country	:	US
Telephone Number	:	979-774-2053
Fax Number	:	979-776-5914

Provider Business Practice Location Address
First Line	:	501 E WASHINGTON AVE
Second Line	:
City	:	NAVASOTA
State	:	TX
Zip	:	77868-3001
Country	:	US
Telephone Number	:	936-825-6444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/27/2017

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Directions to “ POLLACHI P SELVAKUMARRAJ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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