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Organization
VISWAJYOTHI MAMBAPOOR, MD, PA
Active
Organization
VISWAJYOTHI MAMBAPOOR, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VISWAJYOTHI MAMBAPOOR MD (OWNER)
(512) 251-7007
Entity
Organization
Contact information
Practice address
200 N HEATHERWILDE BLVD STE B, PFLUGERVILLE, TX 78660-3530
(512) 251-7007
(512) 251-4442
Mailing address
200 N HEATHERWILDE BLVD STE B, PFLUGERVILLE, TX 78660-3530
(512) 251-7007
(512) 251-4442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L1124
TX
207R00000X
Internal Medicine Physician
L1124
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00662Q
MEDICARE PTAN
—
05
—
146610401
—
TX
Enumeration date
12/14/2009
Last updated
12/14/2009
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