Provider Demographics
NPI:1447278346
Name:BEHARA, SUBRAHMANYAM (MD)
Entity type:Individual
Prefix:
First Name:SUBRAHMANYAM
Middle Name:
Last Name:BEHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6139
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-6139
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-362-2699
Practice Address - Street 1:5520 LEONARDO DA VINCI
Practice Address - Street 2:STE 100
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1422
Practice Address - Country:US
Practice Address - Phone:956-362-3636
Practice Address - Fax:956-362-2699
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1853207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110109905Medicaid
TX110109904Medicaid
TX295319YZ3UMedicare PIN
TX110109904Medicaid
TX295319YNG9Medicare PIN
TX4232189OtherAETNA US HEALTHCARE
TX4232189OtherAETNA US HEALTHCARE
TX295319YNG9Medicare PIN
TX80T053Medicare ID - Type Unspecified
TX4232189OtherAETNA US HEALTHCARE