Organization
FORT BEND INTERNAL MEDICINE AND PEDIATRICS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARI KRISHNA SUSARLA M.D. (PHYSICIAN)
(281) 208-1908
Entity
Organization
Contact information
Practice address
4646 RIVERSTONE BLVD, MISSOURI CITY, TX 77459-6141
(281) 208-1908
Mailing address
PO BOX 17295, SUGAR LAND, TX 77496-7295
(281) 208-1908
(281) 208-1930
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L7205
TX
208000000X
Pediatrics Physician
L7205
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0094PD
BC BS PROVIDER NUMBER
TX
Enumeration date
01/15/2007
Last updated
07/25/2008
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