Provider Demographics
NPI:1871892174
Name:SARADA GUMMADI MD PA
Entity type:Organization
Organization Name:SARADA GUMMADI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARADA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-583-4866
Mailing Address - Street 1:4404 SANTA FABIOLA
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2717 MICHAEL ANGELO
Practice Address - Street 2:SUITE 302
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1408
Practice Address - Country:US
Practice Address - Phone:956-467-8382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062WMOtherBCBS
TX281570601Medicaid
TXTXB128369Medicare PIN