MEDICARE: VENKATA S ERELLA MD PA

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	208200000X	Plastic Surgery Physician	M7167	TX

General Provider Information

NPI Number	:	1609197490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENKATA S ERELLA MD PA

Provider Business Mailing Address
First Line	:	3207 RANCH ROAD 620 S
Second Line	:	SUITE A
City	:	AUSTIN
State	:	TX
Zip	:	78738-6872
Country	:	US
Telephone Number	:	512-730-3885
Fax Number	:	512-730-3875

Provider Business Practice Location Address
First Line	:	3207 RANCH ROAD 620 S
Second Line	:	SUITE A
City	:	AUSTIN
State	:	TX
Zip	:	78738-6872
Country	:	US
Telephone Number	:	512-730-3885
Fax Number	:	512-730-3875

Authorized Official
Title or Position	:	OWNER/RENDERING PROVIDER
Name	:	DR. VENKATA S ERELLA
Credential	:	M.D.
Telephone Number	:	512-730-3885

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	09/10/2014

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