Provider Demographics
NPI:1497739866
Name:CHALLA, VENKATA RAMANA (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:RAMANA
Last Name:CHALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3719 W MARKET ST
Mailing Address - Street 2:STE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1378
Mailing Address - Country:US
Mailing Address - Phone:336-547-6361
Mailing Address - Fax:336-547-6364
Practice Address - Street 1:507 N LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4303
Practice Address - Country:US
Practice Address - Phone:336-883-0029
Practice Address - Fax:336-899-1136
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22900207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14831Medicare UPIN
NC2142342BMedicare ID - Type Unspecified