Provider Demographics
NPI:1699945584
Name:VIDYASAGAR CHODIMELLA, MD, FACC, P.A.
Entity type:Organization
Organization Name:VIDYASAGAR CHODIMELLA, MD, FACC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYASAGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODIMELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-395-7400
Mailing Address - Street 1:4325 N JOSEY LN
Mailing Address - Street 2:SUITE 204
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
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0088207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H22261Medicare UPIN