Provider Demographics
NPI:1275578445
Name:PAVULURI, SRIDEVI (MD)
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:PAVULURI
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:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-0529
Mailing Address - Country:US
Mailing Address - Phone:281-534-9050
Mailing Address - Fax:281-534-9030
Practice Address - Street 1:3828 HUGHES CT
Practice Address - Street 2:SUITE 201
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6244
Practice Address - Country:US
Practice Address - Phone:281-534-9050
Practice Address - Fax:281-534-9030
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178446403Medicaid
TX8CF931OtherBCBSTX
TXTXB100255Medicare PIN
TX8F24256Medicare PIN