Provider Demographics
NPI:1235326828
Name:NATHAN, SRINIVASAN RANGA (MD,)
Entity Type:Individual
Prefix:
First Name:SRINIVASAN
Middle Name:RANGA
Last Name:NATHAN
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 1:9816 MEMORIAL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4206
Mailing Address - Country:US
Mailing Address - Phone:281-446-8114
Mailing Address - Fax:281-446-1158
Practice Address - Street 1:9816 MEMORIAL BLVD
Practice Address - Street 2:206
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4255
Practice Address - Country:US
Practice Address - Phone:281-446-8114
Practice Address - Fax:281-446-1158
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6190207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081671201Medicaid
TX081671201Medicaid
TX85G391Medicare PIN