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General NPI Number Information
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NPI Number | 1255836128
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Entity Type | Individual
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Provider Name | CHELLA R BHAGYAM DO
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Gender | Female
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 70 BOWER DR STE 240
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City | MEDFORD
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State | OR
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Zip | 97501-3689
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Country | US
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Telephone | 541-732-8790
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Fax | 541-732-3415
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone | 541-732-8790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO211472
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | DO211472
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License Number State | OR
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