MEDICARE: MRS. SUSHMA V GORRELA M.D.

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	207Q00000X	Family Medicine Physician	L6740	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063482321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSHMA V GORRELA M.D.

Provider Business Mailing Address
First Line	:	6225 FM 2920 RD
Second Line	:	SUITE 100
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	281-257-5977
Fax Number	:	281-257-5966

Provider Business Practice Location Address
First Line	:	6225 FM 2920 RD
Second Line	:	SUITE 100
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	281-257-5977
Fax Number	:	281-257-5966

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/28/2009

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