Provider Demographics
NPI:1316596869
Name:MALATHI CHAMARTHI RAJU MD PA
Entity Type:Organization
Organization Name:MALATHI CHAMARTHI RAJU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMARTHI-RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-928-5669
Mailing Address - Street 1:PO BOX 100033
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0033
Mailing Address - Country:US
Mailing Address - Phone:817-928-5669
Mailing Address - Fax:817-717-9680
Practice Address - Street 1:203 WALLS DR STE 100
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7029
Practice Address - Country:US
Practice Address - Phone:817-928-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477716116OtherNPI