Provider Demographics
NPI:1992013015
Name:VIVEKANANTHAN, GAITHRI ARUNESH (PA-C)
Entity Type:Individual
Prefix:
First Name:GAITHRI
Middle Name:ARUNESH
Last Name:VIVEKANANTHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8122
Mailing Address - Country:US
Mailing Address - Phone:214-778-1075
Mailing Address - Fax:214-778-1237
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:SUITE 530
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:214-778-1075
Practice Address - Fax:214-778-1237
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07076363AM0700X
TXPA07676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07076OtherPA LICENSE
TX283184403Medicaid
TX283184402Medicaid
TX283184401Medicaid
TXTXB128256Medicare PIN
TXPA07076OtherPA LICENSE
TXTXB128257Medicare PIN