Provider Demographics
NPI:1639165731
Name:PACHIGOLLA, RUPA R (MD)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:R
Last Name:PACHIGOLLA
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 1:2016 FORT WORTH HWY
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4706
Mailing Address - Country:US
Mailing Address - Phone:817-596-8637
Mailing Address - Fax:817-599-3614
Practice Address - Street 1:2016 FORT WORTH HWY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4706
Practice Address - Country:US
Practice Address - Phone:817-596-8637
Practice Address - Fax:817-599-3614
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197261401Medicaid
TXN0337OtherTEXAS LICENSE
TX00Z863OtherMEDICARE GRP PIN
TX197259801OtherMEDICAID GRP
TX8F9223Medicare PIN
TX197261401Medicaid