Provider Demographics
NPI:1346299419
Name:CHALLAPALLI, VIDYA (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:CHALLAPALLI
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:PO BOX 203629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0001
Mailing Address - Country:US
Mailing Address - Phone:915-533-3474
Mailing Address - Fax:915-544-5037
Practice Address - Street 1:1801 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3524
Practice Address - Country:US
Practice Address - Phone:915-521-1200
Practice Address - Fax:866-862-5432
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059918A174400000X, 207L00000X
IL036.108031207L00000X
TXP2210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000367998OtherANTHEM BCBS
IL036108031Medicaid
IN200513740AMedicaid
IL036108031Medicaid
IN200513740AMedicaid
IN148530DDMedicare PIN