Provider Demographics
NPI:1326096900
Name:NALAJALA, VASU (MD)
Entity Type:Individual
Prefix:
First Name:VASU
Middle Name:
Last Name:NALAJALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HOSPITAL PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5935
Mailing Address - Country:US
Mailing Address - Phone:817-354-2680
Mailing Address - Fax:817-510-5927
Practice Address - Street 1:1615 HOSPITAL PKWY STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5935
Practice Address - Country:US
Practice Address - Phone:817-354-2680
Practice Address - Fax:817-510-5927
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17848207Q00000X
TXM4389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126627Medicaid
TX188636805Medicaid
TX188636802Medicaid
TX188636803Medicaid
TX188636804Medicaid
TX188636801Medicaid
TXTXB115611Medicare PIN
TX8J2564Medicare PIN
TX188636802Medicaid
TX188636805Medicaid
TX188636804Medicaid
TXTXB124805Medicare PIN
TXTXB122323Medicare PIN