Provider Demographics
NPI:1629067533
Name:KANCHARLA, KIRAN REDDY (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:REDDY
Last Name:KANCHARLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2021 N MACARTHUR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2226
Practice Address - Country:US
Practice Address - Phone:972-256-3537
Practice Address - Fax:972-255-7916
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2959207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150452402Medicaid
TX150452407Medicaid
TX150452408Medicaid
TX8G2717Medicare PIN