| Viswajyothi Mambapoor, Md, Pa | |
|
200 N Heatherwilde Blvd Ste B Pflugerville TX 78660-3530 | |
| (512) 251-7007 | |
| (512) 251-4442 |
| Full Name | Viswajyothi Mambapoor, Md, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 200 N Heatherwilde Blvd Ste B, Pflugerville, Texas |
| Authorized Official Name and Position | Viswajyothi Mambapoor (OWNER) |
| Authorized Official Contact | 5122517007 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Viswajyothi Mambapoor, Md, Pa 200 N Heatherwilde Blvd Ste B Pflugerville TX 78660-3530 Ph: (512) 251-7007 | Viswajyothi Mambapoor, Md, Pa 200 N Heatherwilde Blvd Ste B Pflugerville TX 78660-3530 Ph: (512) 251-7007 |
| NPI Number | 1326377730 |
|---|---|
| Provider Enumeration Date | 12/14/2009 |
| Last Update Date | 12/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326377730 | NPI | - | NPPES |
| 00662Q | Other | MEDICARE PTAN | |
| 146610401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L1124 (Texas) | Primary |
| 207R00000X | Internal Medicine | L1124 (Texas) | Secondary |
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