Provider Demographics
NPI:1972534113
Name:GOWDA, ANITHA R (MD)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:R
Last Name:GOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITHA
Other - Middle Name:
Other - Last Name:SRIKANTAPPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4710 PLATO PARK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5372
Mailing Address - Country:US
Mailing Address - Phone:832-885-2588
Mailing Address - Fax:281-605-4352
Practice Address - Street 1:4710 PLATO PARK DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5372
Practice Address - Country:US
Practice Address - Phone:832-885-2588
Practice Address - Fax:281-605-4352
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH19745Medicare UPIN