Provider Demographics
NPI:1639353139
Name:BOLLINENI, MAMATHA (MD)
Entity type:Individual
Prefix:DR
First Name:MAMATHA
Middle Name:
Last Name:BOLLINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAMATHA
Other - Middle Name:
Other - Last Name:BOLLINENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 W DEAN KEETON ST CAMPUS MAIL A3900 (UHS)
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-475-8252
Mailing Address - Fax:512-219-0733
Practice Address - Street 1:100 W DEAN KEETON ST CAMPUS MAIL A3900 (UHS)
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-475-8252
Practice Address - Fax:512-219-0733
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246435207R00000X
TXQ1951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare PIN