Provider Demographics
NPI:1558674705
Name:CHALLA, SOUJANYA (MD)
Entity Type:Individual
Prefix:
First Name:SOUJANYA
Middle Name:
Last Name:CHALLA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:DEPARTMENT OF GERIATRIC MEDICINE , MAIL ROUTE-0177
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0177
Mailing Address - Country:US
Mailing Address - Phone:409-266-9634
Mailing Address - Fax:409-747-3585
Practice Address - Street 1:301 UNIVERSITY BLVD MAIL ROUTE 0177
Practice Address - Street 2:DEPARTMENT OF GERIATRIC MEDICINE
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0177
Practice Address - Country:US
Practice Address - Phone:409-266-9634
Practice Address - Fax:409-747-3585
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2013-09-06
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Provider Licenses
StateLicense IDTaxonomies
TXP5785207QA0505X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine