Provider Demographics
NPI:1356480024
Name:MADHAVAN PISHARODI, M.D., P.A.
Entity Type:Organization
Organization Name:MADHAVAN PISHARODI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUBI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-541-6725
Mailing Address - Street 1:3475 W ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9277
Mailing Address - Country:US
Mailing Address - Phone:956-541-6725
Mailing Address - Fax:956-541-2070
Practice Address - Street 1:3475 W ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9277
Practice Address - Country:US
Practice Address - Phone:956-541-6725
Practice Address - Fax:956-541-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0796207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081242201Medicaid
TX081242201Medicaid