Pavani Samudrala, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

BP10058872 Issued in TX

Practice address

707 Bernter Avenue
MD Anderson Cancer Center
Houston, TX 77030

Phone

(713) 792-1631

NPI assigned

Jun 19, 2017

Reactivated

Feb 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Pavani Golla Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519171200000",
    "number": "1487184644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 PRESSLER ST. FCT-13 5081",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77030",
            "telephone_number": "832-882-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 BERNTER AVENUE",
            "address_2": "MD ANDERSON CANCER CENTER",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77030",
            "telephone_number": "713-792-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUDRALA",
        "first_name": "PAVANI",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2018-02-21",
        "deactivation_date": "2018-01-25",
        "reactivation_date": "2018-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "BP10058872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAVANI",
            "last_name": "GOLLA",
            "prefix": "MRS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Samuel J. Yankelove, MD, PA (Eye Laser Specialist, Inc.)

• Emergency Medicine Physician in Houston, TX
• Providers in Houston, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.