Provider Demographics
NPI:1215103916
Name:SPACE CITY ASSOCIATES OF GERIATRICS, PA
Entity type:Organization
Organization Name:SPACE CITY ASSOCIATES OF GERIATRICS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAHARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-997-7406
Mailing Address - Street 1:2301 CARINA CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2879
Mailing Address - Country:US
Mailing Address - Phone:281-997-7406
Mailing Address - Fax:
Practice Address - Street 1:2301 CARINA CT
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2879
Practice Address - Country:US
Practice Address - Phone:281-997-7406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty