Individual
SUSRUTHA THANAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4110 GUADALUPE ST, AUSTIN STATE HOSPITAL, AUSTIN, TX 78751-4223
(512) 419-2148
(512) 419-2163
Mailing address
4110 GUADALUPE ST, AUSTIN STATE HOSPITAL, AUSTIN, TX 78751-4223
(512) 419-2148
(512) 419-2163
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
Q2860
TX
Other
Enumeration date
03/25/2011
Last updated
10/10/2023
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