Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | TR00045282 | WA |
NPI | 1568572519 |
---|---|
Provider Name | Varaha Tammisetti |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 15/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198189601 | (05) | TX |
198189602 | CSHCN (01) | TX |
8AL154 | BCBS (01) | TX |