Provider Demographics
NPI:1982642914
Name:NETAJI, BALIJEPALLI (MD)
Entity Type:Individual
Prefix:DR
First Name:BALIJEPALLI
Middle Name:
Last Name:NETAJI
Suffix:
Gender:M
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:SUITE 245
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5368
Practice Address - Country:US
Practice Address - Phone:512-419-9733
Practice Address - Fax:512-454-4575
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1330207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124483206Medicaid
TXP00646006OtherRAILROAD MEDICARE
TX124483207Medicaid
TX0811853-01Medicaid
TX8BP360OtherBCBS OF TX
TX830007602OtherRAILROAD MEDICARE NUMBER
TX124483205Medicaid
TX124483207Medicaid
TX124483205Medicaid
TX8L1773Medicare PIN
TX8548J1Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX8L1772Medicare PIN