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General NPI Number Information
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NPI Number | 1164790150
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Entity Type | Organization
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Legal Business Name | MALLADI R. SASTRY, MD, PA
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 4100 W 15TH ST SUITE 216
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City | PLANO
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State | TX
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Zip | 75093-5803
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Country | US
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Telephone | 972-596-2135
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Fax | 972-596-7382
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Provider Business Mailing Address
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Address Line | 4100 W 15TH ST SUITE 216
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City | PLANO
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State | TX
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Zip | 75093-5803
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Country | US
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Telephone | 972-596-2135
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Fax | 972-596-7382
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MALLADI R SASTRY
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Credential | M.D.
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Telephone | 972-596-2135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | E4934
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License Number State | TX
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