Provider Demographics
NPI:1093756975
Name:PRABA, ANANT CHELVA (MD)
Entity Type:Individual
Prefix:
First Name:ANANT
Middle Name:CHELVA
Last Name:PRABA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 SAINT MARKS PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1250
Mailing Address - Country:US
Mailing Address - Phone:979-242-5605
Mailing Address - Fax:979-242-5619
Practice Address - Street 1:2 SAINT MARKS PL
Practice Address - Street 2:SUITE 130
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1250
Practice Address - Country:US
Practice Address - Phone:979-242-5605
Practice Address - Fax:979-242-5619
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6669208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043958001Medicaid
TX043958001Medicaid
TXH03176Medicare UPIN