Provider Demographics
NPI:1992982532
Name:ASHWIN GOWDA MD PA
Entity type:Organization
Organization Name:ASHWIN GOWDA MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-440-5757
Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:A-100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7192
Mailing Address - Country:US
Mailing Address - Phone:512-440-5757
Mailing Address - Fax:512-440-5858
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:A-100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7192
Practice Address - Country:US
Practice Address - Phone:512-440-5757
Practice Address - Fax:512-440-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5347207RS0012X, 2080S0012X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0002RBOtherBCBS GROUP #
TX6242690001Medicare NSC
TX00Z505Medicare PIN