Provider Demographics
NPI:1689625279
Name:VODNALA, SRINIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:
Last Name:VODNALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SRINIVAS
Other - Middle Name:
Other - Last Name:VODNALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13219 DOTSON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4308
Mailing Address - Country:US
Mailing Address - Phone:281-955-0338
Mailing Address - Fax:281-469-0741
Practice Address - Street 1:13219 DOTSON RD STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4308
Practice Address - Country:US
Practice Address - Phone:281-955-0338
Practice Address - Fax:281-469-0741
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7242207RC0200X, 207RP1001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161433101Medicaid
TXH94803Medicare UPIN
TX161433101Medicaid