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Contact Information

MADAIAH REVANA MD PA
9816 MEMORIAL BLVD
STE 107 STE 120 (TESTING)
HUMBLE, TX77338-4205
 Phone: 281-446-4638
 Fax: 281-973-9454
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Cardiology

207RI0011X 11 Physician/Internal Medicine
 

Nuclear Imaging & Therapy

207UN0902X 36 Physician/Nuclear Medicine
Indicates primary specialty

NPI Profile & details for MADAIAH REVANA MD PA

NPI # 1477768141
LBN Legal business name MADAIAH REVANA MD PA
Authorized official MADAIAH REVANA - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/14/2007
Last updated 02/03/2026 - About 4 months ago
Identifiers
TX Medicaid 359911001
TX Other 10016000 AMERIGROUP
TX Other 82G136 BCBS
TX Other 390396 WELLCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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