Provider Demographics
NPI:1477716116
Name:CHAMARTHI RAJU, MALATHI (MD)
Entity Type:Individual
Prefix:
First Name:MALATHI
Middle Name:
Last Name:CHAMARTHI RAJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALATHI
Other - Middle Name:
Other - Last Name:CHAMARTHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-877-5858
Mailing Address - Fax:817-335-4418
Practice Address - Street 1:203 WALLS DR STE 100
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7029
Practice Address - Country:US
Practice Address - Phone:817-928-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2025207R00000X, 207RN0300X
NJMA082562207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206758903Medicaid
TX8L17349Medicare PIN
TX296148YSE6Medicare PIN