Provider Demographics
NPI:1386645406
Name:VASSA, RAJENDRA CHHOTALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:CHHOTALAL
Last Name:VASSA
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:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8145
Mailing Address - Country:US
Mailing Address - Phone:972-548-5363
Mailing Address - Fax:
Practice Address - Street 1:6171 VIRGINIA PKWY
Practice Address - Street 2:200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5605
Practice Address - Country:US
Practice Address - Phone:972-548-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics