=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538121256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROOPA CHALLAPALLI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 01/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 PORTLAND AVE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14621-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-922-4394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 CARTERS GRV
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-419-6824
-----------------------------------------------------
Fax | 585-419-6823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | 182677
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------