Provider Demographics
NPI:1639164437
Name:CHADALAWADA, DURGARANI (MD)
Entity Type:Individual
Prefix:
First Name:DURGARANI
Middle Name:
Last Name:CHADALAWADA
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 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-4466
Mailing Address - Fax:937-440-7177
Practice Address - Street 1:3130 N COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-4466
Practice Address - Fax:937-440-7177
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095742208M00000X, 207Q00000X
PAMD427516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014140970001Medicaid
PA902560OtherHIGHMARK BLUE SHIELD
PAP00258909OtherPALMETTO GBA-RAILROAD MEDICARE
PA1014140970002Medicaid
PA410893OtherUPMC HEALTH PLAN
PA251754199019OtherMEDICAL MUTUAL OF OHIO
OH3146698Medicaid
PAI44354OtherHEALTH AMERICA
PAI44354OtherHEALTH AMERICA
PAP00258909OtherPALMETTO GBA-RAILROAD MEDICARE
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PA095488JJNMedicare PIN