Provider Demographics
NPI:1023314739
Name:PENAGALURU, NEENA M (MD)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:M
Last Name:PENAGALURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NEENA
Other - Middle Name:
Other - Last Name:BATHULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6256
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-395-4012
Practice Address - Street 1:2660 E COMMON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3585
Practice Address - Country:US
Practice Address - Phone:830-620-4650
Practice Address - Fax:830-620-4657
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5871207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01258507OtherMEDICARE RAIL ROAD
TX328588401Medicaid
TX299601YS6NMedicare PIN