Provider Demographics
NPI:1154313013
Name:NARRA, SUBRAHMANYAM (MD)
Entity Type:Individual
Prefix:
First Name:SUBRAHMANYAM
Middle Name:
Last Name:NARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:NARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12411 HYMEADOW DR STE 3E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1829
Mailing Address - Country:US
Mailing Address - Phone:512-331-5321
Mailing Address - Fax:512-251-6774
Practice Address - Street 1:12411 HYMEADOW DR
Practice Address - Street 2:STE 3E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1874
Practice Address - Country:US
Practice Address - Phone:512-331-5321
Practice Address - Fax:512-331-8012
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6978207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX46561OtherFIRST HEALTH
4089872OtherAETNA/TRS
300451OtherGREAT WEST
060027797AOtherRAILROAD MEDICARE
060039605OtherRAILROAD MEDICARE
TX123207604Medicaid
TX0055REOtherBCBS
TX123207604Medicaid
TX46561OtherFIRST HEALTH