Provider Demographics
NPI:1720210727
Name:SWAMY, GAYATHRI (MD)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:SWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYATHRI
Other - Middle Name:
Other - Last Name:MUTHUKRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1032
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:512-218-6330
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437780207R00000X, 208M00000X
TXQ5231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024010750003Medicaid
PA1024010750003Medicaid