Provider Demographics
NPI:1518195825
Name:CHALLA, ANURADHA C (MD,)
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:C
Last Name:CHALLA
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:ANU
Other - Middle Name:C
Other - Last Name:CHALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:323 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1537
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:
Practice Address - Street 1:800 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3410
Practice Address - Country:US
Practice Address - Phone:828-696-4250
Practice Address - Fax:828-696-4256
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-003122084P0800X
MI43010948112084P0800X
CAC1619742084P0800X
KYTP3912084P0800X
KY497092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100428100Medicaid
NCNN8165AOtherMEDICARE PTAN