Provider Demographics
NPI:1366440653
Name:TAMERISA, RADHA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:ANN
Last Name:TAMERISA
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 1:25230 KINGSLAND BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3256
Mailing Address - Country:US
Mailing Address - Phone:281-869-3009
Mailing Address - Fax:832-437-5182
Practice Address - Street 1:25230 KINGSLAND BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3256
Practice Address - Country:US
Practice Address - Phone:281-869-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7210207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI57015Medicare UPIN
TX8G6946Medicare PIN