Provider Demographics
NPI:1124116132
Name:VISHU LAMMATA MD PA
Entity type:Organization
Organization Name:VISHU LAMMATA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VISHU
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMMATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-572-1600
Mailing Address - Street 1:PO BOX 380577
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-0577
Mailing Address - Country:US
Mailing Address - Phone:972-572-1600
Mailing Address - Fax:972-572-2133
Practice Address - Street 1:925 YORK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2043
Practice Address - Country:US
Practice Address - Phone:972-572-1600
Practice Address - Fax:972-572-2133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISWANADHAM LAMMATA MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082PYOtherBCBS
TX0082PYOtherBCBS
TXC18112Medicare UPIN