1316188519 NPI number — DR. SOWMYA PUTHALAPATTU M.D

Table of content: DR. SOWMYA PUTHALAPATTU M.D (NPI 1316188519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316188519 NPI number — DR. SOWMYA PUTHALAPATTU M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTHALAPATTU
Provider First Name:
SOWMYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316188519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 KINGWOOD MEDICAL DR
Provider Second Line Business Mailing Address:
STE B200
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77339-6016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-401-9540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19502 MCKAY BLVD
Provider Second Line Business Practice Location Address:
SUITE- 200
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-5707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-540-8779
Provider Business Practice Location Address Fax Number:
281-540-8798
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  N1841 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: N1841 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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