Provider Demographics
NPI:1972645406
Name:BATTULA, PADMAJA P (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAJA
Middle Name:P
Last Name:BATTULA
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 1:8511 EASTON LN
Mailing Address - Street 2:APT 211
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-2744
Mailing Address - Country:US
Mailing Address - Phone:817-460-3471
Mailing Address - Fax:
Practice Address - Street 1:8511 EASTON LN
Practice Address - Street 2:APT 211
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-2744
Practice Address - Country:US
Practice Address - Phone:817-460-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164398303Medicaid
TX610235Medicare PIN
TX303305ZM10Medicare PIN
TXH46080Medicare UPIN