Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G0796 | TX |
NPI | 1083685812 |
---|---|
Provider Name | Madhavan Pisharodi |
First Address | Brownsville, TX 78520-9277 |
Second Address | Brownsville, TX 78520-9277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
081242201 | (05) | TX |
110116402 | (05) | TX |
D73558 | (02) | TX |