Sreedhar Polavarapu MD PA

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

L9431 Issued in TX

Legal business name

SREEDHAR POLAVARAPU MD PA

Practice address

2501 Jimmy Johnson Blvd
Suite 207
Port Arthur, TX 77642

Phone

(409) 722-7500

Fax

(409) 293-4401

NPI assigned

Oct 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sreedhar Polavarapu, MD

Title

President

Phone

(409) 722-7500

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114009586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 JIMMY JOHNSON BLVD",
            "address_2": "SUITE 207",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "77642",
            "telephone_number": "409-722-7500",
            "fax_number": "409-293-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 JIMMY JOHNSON BLVD",
            "address_2": "SUITE 207",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "77642",
            "telephone_number": "409-722-7500",
            "fax_number": "409-293-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SREEDHAR POLAVARAPU MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLAVARAPU",
        "authorized_official_first_name": "SREEDHAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "409-722-7500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "L9431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Port Arthur, TX
• Providers in Port Arthur, TX by specialty
• Geriatric Medicine (Internal Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.