Provider Demographics
NPI:1780083337
Name:BENARJI TEGALA MD PA
Entity type:Organization
Organization Name:BENARJI TEGALA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENARJI
Authorized Official - Middle Name:
Authorized Official - Last Name:TEGALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-640-4700
Mailing Address - Street 1:1211 E 6TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4094
Mailing Address - Country:US
Mailing Address - Phone:903-640-4700
Mailing Address - Fax:903-640-1975
Practice Address - Street 1:1211 E 6TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4094
Practice Address - Country:US
Practice Address - Phone:903-640-4700
Practice Address - Fax:903-640-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty