Provider Demographics
NPI:1538121256
Name:CHALLAPALLI, ROOPA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOPA
Middle Name:
Last Name:CHALLAPALLI
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 1:2 CARTERS GRV
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3053
Mailing Address - Country:US
Mailing Address - Phone:585-419-6824
Mailing Address - Fax:585-419-6823
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1826772084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
430738OtherVALUEOPTIONS, INC. (MVP HEALTH CARE)
102645EUOtherPREFERRED CARE
P010182677OtherBCBS
0007596382OtherAETNA
NY01245683Medicaid
102645EUOtherPREFERRED CARE
NY01245683Medicaid