Provider Demographics
NPI:1275876039
Name:KAVITHA MOOLAMALLA,MD.PA
Entity Type:Organization
Organization Name:KAVITHA MOOLAMALLA,MD.PA
Other - Org Name:KAVITHA MOOLAMALLA,MD.PA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOLAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-644-5360
Mailing Address - Street 1:8080 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2900
Mailing Address - Country:US
Mailing Address - Phone:214-644-5360
Mailing Address - Fax:214-644-5364
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 240
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2900
Practice Address - Country:US
Practice Address - Phone:214-644-5360
Practice Address - Fax:214-644-5364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-30
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG62226Medicare UPIN