Provider Demographics
NPI:1942689880
Name:ASHA KANCHARLA MD PA
Entity Type:Organization
Organization Name:ASHA KANCHARLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-1940
Mailing Address - Street 1:300 WILLOW CREEK PKWY
Mailing Address - Street 2:210 A
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4421
Mailing Address - Country:US
Mailing Address - Phone:903-723-1940
Mailing Address - Fax:903-723-9891
Practice Address - Street 1:300 WILLOW CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4421
Practice Address - Country:US
Practice Address - Phone:903-723-1940
Practice Address - Fax:903-723-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4014207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC0364OtherMEDICARE RR
TX00S2S2OtherBCBS
TX411412Medicare PIN