Provider Demographics
NPI:1093823809
Name:RUMALLA, SUDHAKAR (MD)
Entity Type:Individual
Prefix:
First Name:SUDHAKAR
Middle Name:
Last Name:RUMALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MATLOCK CENTRE CIR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2535
Mailing Address - Country:US
Mailing Address - Phone:817-277-4799
Mailing Address - Fax:817-275-0202
Practice Address - Street 1:625 MATLOCK CENTRE CIR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2535
Practice Address - Country:US
Practice Address - Phone:817-277-4799
Practice Address - Fax:817-275-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BB04Medicare ID - Type Unspecified
TXC21414Medicare UPIN