Provider Demographics
NPI:1760586317
Name:NANDAKUMAR, BHANUMATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHANUMATHI
Middle Name:
Last Name:NANDAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BHANUMATHI
Other - Middle Name:GOVINDACHETTY
Other - Last Name:AKALU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 160252
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78280-2452
Mailing Address - Country:US
Mailing Address - Phone:210-227-3701
Mailing Address - Fax:210-227-8628
Practice Address - Street 1:215 N SAN SABA ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207
Practice Address - Country:US
Practice Address - Phone:210-227-3701
Practice Address - Fax:210-227-8628
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1733208000000X
OH35036054N208000000X
NY120970208000000X
MS08890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121464501Medicaid
TX121464501Medicaid
E60810Medicare UPIN