Provider Demographics
NPI:1033377692
Name:WAGHELA, SARJU (DO)
Entity Type:Individual
Prefix:DR
First Name:SARJU
Middle Name:
Last Name:WAGHELA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:#630
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2256
Practice Address - Country:US
Practice Address - Phone:972-256-3537
Practice Address - Fax:972-255-7916
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204308502Medicaid
TX204308501Medicaid
TX204308503Medicaid
TXP00868149OtherRAILROAD MEDICARE
TX204308503Medicaid
TX204308501Medicaid
TXTXB118862Medicare PIN