Provider Demographics
NPI:1346245024
Name:PACHALLA, SARAT CHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SARAT
Middle Name:CHANDRA
Last Name:PACHALLA
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 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:816-461-6837
Mailing Address - Fax:816-833-1760
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 220
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-461-6837
Practice Address - Fax:816-833-1760
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000158765207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205265408Medicaid
MOH32189Medicare UPIN
MOJ38A923Medicare ID - Type Unspecified