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NPI Code Detail

MEDICARE: SRIDHAR VASIREDDY MD

MEDICARE:   SRIDHAR  VASIREDDY  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
1207LP2900XPain Medicine (Anesthesiology) PhysicianM4615TX
2208VP0014XInterventional Pain Medicine PhysicianM4615TX
3174400000XSpecialistM4615TX
4207L00000XAnesthesiology PhysicianM4615TX

General Provider Information

NPI Number : 1144214966
Entity Type Code : Individual
Provider Name (Legal Business Name) : SRIDHAR VASIREDDY MD
Provider Business Mailing Address
First Line : 110 STONE OAK LOOP
Second Line : SUITE 103
City : SAN ANTONIO
State : TX
Zip : 78258-3510
Country : US
Telephone Number : 210-268-0129
Fax Number : 210-497-3593
Provider Business Practice Location Address
First Line : 110 STONE OAK LOOP
Second Line : SUITE 103
City : SAN ANTONIO
State : TX
Zip : 78258-3510
Country : US
Telephone Number : 210-268-0129
Fax Number : 210-497-3593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 08/08/2025

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