Individual
SOUMYA NERAVETLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
(254) 215-9722
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
066970
GA
208600000X
Surgery Physician
35.129702
OH
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
066970
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35.129702
OH
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
V2646
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0189204
—
OH
01
—
12455059
CAQH
—
Enumeration date
09/23/2008
Last updated
02/19/2025
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