Organization
FORT BEND INTERNAL MEDICINE AND PEDIATRICS, P.A.
Active
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
Update your record
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