Provider Demographics
NPI:1093722019
Name:ACHARYA, SIDDHARTHA ARJUNDEVA (MD)
Entity type:Individual
Prefix:
First Name:SIDDHARTHA
Middle Name:ARJUNDEVA
Last Name:ACHARYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SID
Other - Middle Name:A
Other - Last Name:ACHARYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 890089
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0089
Mailing Address - Country:US
Mailing Address - Phone:409-945-5444
Mailing Address - Fax:409-945-4133
Practice Address - Street 1:6807 EMMETT F LOWRY EXPRESSWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-945-5444
Practice Address - Fax:409-945-4133
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3417207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8477N0Medicare ID - Type Unspecified
E74446Medicare UPIN