Provider Demographics
NPI:1053319897
Name:MOVVA, PRASAD V (MD)
Entity Type:Individual
Prefix:MR
First Name:PRASAD
Middle Name:V
Last Name:MOVVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3315
Mailing Address - Country:US
Mailing Address - Phone:956-428-6695
Mailing Address - Fax:
Practice Address - Street 1:922 E TYLER AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7134
Practice Address - Country:US
Practice Address - Phone:956-440-7000
Practice Address - Fax:956-440-7042
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00069TMedicare ID - Type Unspecified
TXG77372Medicare UPIN