Provider Demographics
NPI:1013258797
Name:BABBILI, ANANDA D (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANANDA
Middle Name:D
Last Name:BABBILI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 BEDFORD EULESS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7214
Mailing Address - Country:US
Mailing Address - Phone:817-581-3781
Mailing Address - Fax:817-581-3768
Practice Address - Street 1:8208 BEDFORD EULESS RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7214
Practice Address - Country:US
Practice Address - Phone:817-581-3781
Practice Address - Fax:817-581-3768
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00793363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical