Provider Demographics
NPI:1508962606
Name:DRONAVALLI, GOUTHAM (MD)
Entity Type:Individual
Prefix:
First Name:GOUTHAM
Middle Name:
Last Name:DRONAVALLI
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 1:5410 KING PLAINS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-7046
Mailing Address - Country:US
Mailing Address - Phone:281-723-9120
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST STE 2500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1537
Practice Address - Country:US
Practice Address - Phone:713-704-4300
Practice Address - Fax:713-704-5745
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5020207RP1001X
TN41462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD41462OtherSTATE LICENSE
TXTXB119417Medicare PIN
TNMD41462OtherSTATE LICENSE
TXTXB119217Medicare PIN