Provider Demographics
NPI:1609197490
Name:VENKATA S ERELLA MD PA
Entity Type:Organization
Organization Name:VENKATA S ERELLA MD PA
Other - Org Name:ASPIRA PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RENDERING PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-730-3885
Mailing Address - Street 1:3207 RANCH ROAD 620 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6872
Mailing Address - Country:US
Mailing Address - Phone:512-730-3885
Mailing Address - Fax:512-730-3875
Practice Address - Street 1:3207 RANCH ROAD 620 S
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6872
Practice Address - Country:US
Practice Address - Phone:512-730-3885
Practice Address - Fax:512-730-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7167208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty