Provider Demographics
NPI:1912197518
Name:FERNANDO, SAVITHRI HAPUHENNADIGE (MD)
Entity type:Individual
Prefix:
First Name:SAVITHRI
Middle Name:HAPUHENNADIGE
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-4045
Mailing Address - Country:US
Mailing Address - Phone:361-782-3560
Mailing Address - Fax:361-782-3560
Practice Address - Street 1:1013 S WELLS ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-4045
Practice Address - Country:US
Practice Address - Phone:361-782-3560
Practice Address - Fax:361-782-3560
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7969207Q00000X, 2083X0100X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6943OtherBLUE CROSS
TX8F6943OtherBLUE CROSS
TX8L19951Medicare PIN