Provider Demographics
NPI:1437252772
Name:WALIA, USHA (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:
Last Name:WALIA
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 1:2719 NORTHRIDGE DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4142
Mailing Address - Country:US
Mailing Address - Phone:817-577-8580
Mailing Address - Fax:817-282-8141
Practice Address - Street 1:2719 NORTHRDGE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4142
Practice Address - Country:US
Practice Address - Phone:817-577-8580
Practice Address - Fax:817-282-8141
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ07192084N0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034396401Medicaid
TX11108851OtherCAQH
TX1306084793OtherGROUP NPI
TX034396401Medicaid
TX1306084793OtherGROUP NPI
TXA97907Medicare UPIN