Provider Demographics
NPI:1104823483
Name:VATSALA, SRINIVASACHARI (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASACHARI
Middle Name:
Last Name:VATSALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 1840, SCURLOCK TOWER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-799-2050
Mailing Address - Fax:713-799-2951
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 1840
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-799-2050
Practice Address - Fax:713-799-2951
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6148207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27277Medicare UPIN
00MK02Medicare ID - Type Unspecified