Provider Demographics
NPI:1275897076
Name:GAVIRNENI, MADHAVI (MD)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:GAVIRNENI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-4642
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:817-740-8612
Practice Address - Street 1:2909 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4642
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-740-8612
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53236208000000X
TXQ8890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714470OtherGROUP MEDICARE