Provider Demographics
NPI:1194097139
Name:POORNIMA CHADALAWADA, MD,PA
Entity type:Organization
Organization Name:POORNIMA CHADALAWADA, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POORNIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADALAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-283-2370
Mailing Address - Street 1:2727 BOLTON BOONE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 BOLTON BOONE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:972-283-2370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty