Provider Demographics
NPI:1427012913
Name:CHOLLETI, RAJANARENDER REDDY (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:RAJANARENDER
Middle Name:REDDY
Last Name:CHOLLETI
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NW ELLISON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4739
Mailing Address - Country:US
Mailing Address - Phone:817-426-4700
Mailing Address - Fax:817-426-4737
Practice Address - Street 1:121 NW ELLISON ST STE 105
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4739
Practice Address - Country:US
Practice Address - Phone:817-426-4700
Practice Address - Fax:817-426-4737
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209133174400000X
TXL0089207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086GPOtherBCBS
TX040329702Medicaid
TX7827163OtherAETNA
TX90116910OtherPACIFICARE
TX10030775OtherAMERIGROUP
TX110224533OtherRAILROAD MEDICARE
TX10030775OtherAMERIGROUP
TX040329702Medicaid