Provider Demographics
NPI:1457429052
Name:SAVITA KOOLWAL,MD.PA
Entity type:Organization
Organization Name:SAVITA KOOLWAL,MD.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-971-9121
Mailing Address - Street 1:214 W SAM HOUSTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5346
Mailing Address - Country:US
Mailing Address - Phone:956-971-9121
Mailing Address - Fax:956-283-0641
Practice Address - Street 1:214 W SAM HOUSTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5346
Practice Address - Country:US
Practice Address - Phone:956-971-9121
Practice Address - Fax:956-283-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7772207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080289401Medicaid
TX0027BVOtherBLUE CROSS GRP
TX0027BVMedicare PIN
TXE89586Medicare UPIN