Provider Demographics
NPI:1083025902
Name:PERERA, EKTA K (MD)
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:K
Last Name:PERERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EKTA
Other - Middle Name:
Other - Last Name:KAKKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:713-500-6876
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST FL 6
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-500-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0007425207K00000X
TXBP10049461207R00000X
NY305901207R00000X, 207RA0201X
TXR3691207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine