Healthcare Provider Details

I. General information

NPI: 1528144250
Provider Name (Legal Business Name): JYOTHI CHALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W NORTH ST
SPRINGFIELD OH
45504-2547
US

IV. Provider business mailing address

148 W NORTH ST
SPRINGFIELD OH
45504-2547
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-5001
  • Fax: 937-684-9991
Mailing address:
  • Phone: 937-323-5001
  • Fax: 937-684-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.009463
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.090143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: