Provider Demographics
NPI:1780693648
Name:ACHANTA, VENKATASUBBARAYA CHOWDARY (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATASUBBARAYA
Middle Name:CHOWDARY
Last Name:ACHANTA
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 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-221-5971
Mailing Address - Fax:
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5846
Practice Address - Country:US
Practice Address - Phone:432-221-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036166943207R00000X, 208M00000X
IDM-16070208M00000X
TXM3836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193364003Medicaid
TX193364001Medicaid
TX8AC871OtherBCBS
TX8AU022OtherBCBS TX
TX193364003Medicaid
TX193364001Medicaid
TX264052YPA5Medicare PIN
TX264052YMSKMedicare PIN
TX8AC871OtherBCBS
TX264052YKP5Medicare PIN