Provider Demographics
NPI:1518962588
Name:VADUGANATHAN, PERIYANAN (MD)
Entity Type:Individual
Prefix:
First Name:PERIYANAN
Middle Name:
Last Name:VADUGANATHAN
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 1:11914 ASTORIA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6046
Mailing Address - Country:US
Mailing Address - Phone:281-481-5444
Mailing Address - Fax:281-481-5460
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6046
Practice Address - Country:US
Practice Address - Phone:281-481-5444
Practice Address - Fax:281-481-5460
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7240207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148398401Medicaid
TX148398401Medicaid
TXG31832Medicare UPIN