Provider Demographics
NPI:1811920028
Name:JATLA, KALPANA KASALA (MD)
Entity type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:KASALA
Last Name:JATLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KALPANA
Other - Middle Name:
Other - Last Name:KASALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4337 TERAVISTA CLUB DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1647
Mailing Address - Country:US
Mailing Address - Phone:512-244-7200
Mailing Address - Fax:
Practice Address - Street 1:4337 TERAVISTA CLUB DR STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1647
Practice Address - Country:US
Practice Address - Phone:512-244-7200
Practice Address - Fax:512-868-3907
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8058207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX830503079OtherTAX ID
NJ223485583OtherTAX ID
NJ113817OtherOPERATING ENGINEERS 825
NJ2796048000OtherAMERIHEALTH
NJ1388176OtherAETNA
NJP00367557OtherPALMETTO GBA
PAI31633Medicare UPIN
NJ1388176OtherAETNA
NJ107293A2TMedicare PIN
NJP00367557OtherPALMETTO GBA