Provider Demographics
NPI:1770860751
Name:SODHA MEDICAL PA
Entity Type:Organization
Organization Name:SODHA MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAV
Authorized Official - Middle Name:K
Authorized Official - Last Name:TELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-956-5541
Mailing Address - Street 1:405 STATE HIGHWAY 121 BYP
Mailing Address - Street 2:BUILDING A SUITE 150
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8214
Mailing Address - Country:US
Mailing Address - Phone:972-956-5541
Mailing Address - Fax:
Practice Address - Street 1:108 SAN GABRIEL DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3350
Practice Address - Country:US
Practice Address - Phone:972-956-5541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM28542081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty