Provider Demographics
NPI:1396078291
Name:MAVURAM, SREECHARAN REDDY (MD)
Entity type:Individual
Prefix:
First Name:SREECHARAN REDDY
Middle Name:
Last Name:MAVURAM
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 1:202 BALTIMORE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1907
Mailing Address - Country:US
Mailing Address - Phone:210-725-4646
Mailing Address - Fax:
Practice Address - Street 1:202 BALTIMORE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1907
Practice Address - Country:US
Practice Address - Phone:210-299-8000
Practice Address - Fax:210-299-8099
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA41162207R00000X
MO2009020450207R00000X, 208000000X
TXU5870207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics