Provider Demographics
NPI:1225012271
Name:KANCHARLA, ASHA (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:KANCHARLA
Suffix:
Gender:F
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:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-2427
Mailing Address - Country:US
Mailing Address - Phone:903-723-2465
Mailing Address - Fax:903-723-9891
Practice Address - Street 1:300 WILLOW CREEK PKWY
Practice Address - Street 2:SUITE 210A
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4389
Practice Address - Country:US
Practice Address - Phone:903-723-1940
Practice Address - Fax:903-723-9891
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4014207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8D1609Medicare PIN
I08606Medicare UPIN
P00174668Medicare PIN