Provider Demographics
NPI:1396822177
Name:BHALLA, PRABHA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHA
Middle Name:
Last Name:BHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLAM
Other - Middle Name:
Other - Last Name:PRABHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11914 ASTORIA BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6064
Mailing Address - Country:US
Mailing Address - Phone:281-484-1186
Mailing Address - Fax:281-922-1580
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:281-484-1186
Practice Address - Fax:281-922-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FW68OtherBC/BS
TX098435301Medicaid
TXB21253Medicare UPIN
TX0899520001Medicare NSC
TX00FW68OtherBC/BS