Provider Demographics
NPI:1265465686
Name:SRINIVASAMURTHY, NAGARAJA R (MD)
Entity Type:Individual
Prefix:
First Name:NAGARAJA
Middle Name:R
Last Name:SRINIVASAMURTHY
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:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:1712 1ST ST E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5238
Practice Address - Country:US
Practice Address - Phone:281-446-4139
Practice Address - Fax:281-446-4860
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88Y336OtherBCBS
TX88Y336OtherBCBS
TX88Y336Medicare PIN