Provider Demographics
NPI:1740442144
Name:GILLALA, VARSHA (DO)
Entity type:Individual
Prefix:
First Name:VARSHA
Middle Name:
Last Name:GILLALA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5598
Mailing Address - Country:US
Mailing Address - Phone:432-614-0350
Mailing Address - Fax:432-520-1666
Practice Address - Street 1:2002 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5598
Practice Address - Country:US
Practice Address - Phone:432-614-0350
Practice Address - Fax:915-613-0946
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1867208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation