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NPI Code Detail

MEDICARE: MURALI VATHADA MD

MEDICARE: MURALI VATHADA 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 Physician040270GA
2208000000XPediatrics PhysicianN5454TX

Other Identifiers

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

General Provider Information

NPI Number : 1639121072
Entity Type Code : Individual
Provider Name (Legal Business Name) : MURALI VATHADA MD
Provider Business Mailing Address
First Line : 205 E UNIVERSITY AVE
Second Line : SUITE 200
City : GEORGETOWN
State : TX
Zip : 78626-6814
Country : US
Telephone Number : 512-868-1124
Fax Number : 512-868-9894
Provider Business Practice Location Address
First Line : 200 NOLA RUTH BLVD
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-6074
Country : US
Telephone Number : 877-800-5722
Fax Number : 254-238-9294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 10/12/2017

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Directions to “ MURALI VATHADA MD” Practice Location

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