Provider Demographics
NPI:1881636231
Name:SRIVASTAVA, ARCHANA (MD)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
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:PO BOX 975300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5300
Mailing Address - Country:US
Mailing Address - Phone:214-946-8856
Mailing Address - Fax:214-946-5848
Practice Address - Street 1:4305 W WHEATLAND RD STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3311
Practice Address - Country:US
Practice Address - Phone:972-296-0845
Practice Address - Fax:972-709-1790
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3141207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147317501Medicaid
TX8029M2OtherBCBS
060067428OtherRAILROAD MDCR
TX147317501Medicaid
060067428OtherRAILROAD MDCR