Provider Demographics
NPI:1780705541
Name:CENTRAL TEXAS ALLERGY & ASTHMA, PA
Entity type:Organization
Organization Name:CENTRAL TEXAS ALLERGY & ASTHMA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-625-7612
Mailing Address - Street 1:705 LANDA ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6163
Mailing Address - Country:US
Mailing Address - Phone:830-625-7612
Mailing Address - Fax:830-627-9357
Practice Address - Street 1:705 LANDA ST
Practice Address - Street 2:SUITE F
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6172
Practice Address - Country:US
Practice Address - Phone:830-625-7612
Practice Address - Fax:830-627-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2629207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099025101Medicaid
0A3860Medicare UPIN