Provider Demographics
NPI:1396835427
Name:MUTHAPPA, BACHARANIANDA CHENGAPPA (MD, FRCS)
Entity Type:Individual
Prefix:DR
First Name:BACHARANIANDA
Middle Name:CHENGAPPA
Last Name:MUTHAPPA
Suffix:
Gender:M
Credentials:MD, FRCS
Other - Prefix:DR
Other - First Name:BACHARANIANDA
Other - Middle Name:C
Other - Last Name:MUTHAPPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:120 FARM ROAD 2825
Mailing Address - Street 2:P O BOX 1429
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426-3348
Mailing Address - Country:US
Mailing Address - Phone:903-427-2201
Mailing Address - Fax:903-427-3204
Practice Address - Street 1:120 FARM ROAD 2825
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-3348
Practice Address - Country:US
Practice Address - Phone:903-427-2201
Practice Address - Fax:903-427-3204
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0268207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000BN34OtherBCBS PROVIDER NUMBER
TX1225203-04Medicaid
TX00BN34Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX1225203-04Medicaid