Provider Demographics
NPI:1427040815
Name:POLAVARAPU, SREEDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SREEDHAR
Middle Name:
Last Name:POLAVARAPU
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 1:3216 NEDERLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7025
Mailing Address - Country:US
Mailing Address - Phone:409-722-7500
Mailing Address - Fax:409-293-4401
Practice Address - Street 1:3216 NEDERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7025
Practice Address - Country:US
Practice Address - Phone:409-722-7500
Practice Address - Fax:409-293-4401
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-9431207R00000X
TXL9431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178686501Medicaid
TX178686501Medicaid
0598XMedicare PIN