Provider Demographics
NPI:1255685608
Name:SARMA S CHALLA M.D., P.A.
Entity Type:Organization
Organization Name:SARMA S CHALLA M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-420-2391
Mailing Address - Street 1:4002 GARTH ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3179
Mailing Address - Country:US
Mailing Address - Phone:281-420-2391
Mailing Address - Fax:
Practice Address - Street 1:4002 GARTH ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3179
Practice Address - Country:US
Practice Address - Phone:281-420-2391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128840902Medicaid
TX128840902Medicaid