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NPI Code Detail

MEDICARE: VASUDHA MANTRAVADI MD

MEDICARE:   VASUDHA  MANTRAVADI  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
1208000000XPediatrics Physician2019023011MO
2207K00000XAllergy & Immunology PhysicianT1453TX

General Provider Information

NPI Number : 1316491210
Entity Type Code : Individual
Provider Name (Legal Business Name) : VASUDHA MANTRAVADI MD
Provider Business Mailing Address
First Line : 14140 SOUTHWEST FWY STE 200
Second Line :
City : SUGAR LAND
State : TX
Zip : 77478-3842
Country : US
Telephone Number : 281-649-7000
Fax Number : 281-240-0030
Provider Business Practice Location Address
First Line : 16545 SOUTHWEST FWY STE 100
Second Line :
City : SUGAR LAND
State : TX
Zip : 77479-2919
Country : US
Telephone Number : 281-649-7200
Fax Number : 281-491-6704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 07/29/2021

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Directions to “ VASUDHA MANTRAVADI MD” Practice Location

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