Provider Demographics
NPI:1215972419
Name:CHODIMELLA, VIDYASAGAR (MD)
Entity type:Individual
Prefix:DR
First Name:VIDYASAGAR
Middle Name:
Last Name:CHODIMELLA
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 1:4325 N JOSEY LN
Mailing Address - Street 2:SUITE 204, PLAZA 3
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4635
Mailing Address - Country:US
Mailing Address - Phone:972-395-7400
Mailing Address - Fax:
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:SUITE 204, PLAZA 3
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:972-395-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH22261207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH11151Medicare UPIN