Provider Demographics
NPI:1265635189
Name:PACHIGOLLA, GOWRI (MD)
Entity Type:Individual
Prefix:DR
First Name:GOWRI
Middle Name:
Last Name:PACHIGOLLA
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 1:634 UPTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3507
Mailing Address - Country:US
Mailing Address - Phone:972-637-1300
Mailing Address - Fax:866-353-7586
Practice Address - Street 1:634 UPTOWN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3507
Practice Address - Country:US
Practice Address - Phone:972-637-1300
Practice Address - Fax:866-353-7586
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0336207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659467306Medicaid
BP2-0022421OtherINSTITUTIONAL PERMIT
TX1356513345Medicaid