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General NPI Number Information
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NPI Number | 1942689880
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Entity Type | Organization
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Legal Business Name | ASHA KANCHARLA MD PA
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 300 WILLOW CREEK PKWY
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City | PALESTINE
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State | TX
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Zip | 75801-4421
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Country | US
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Telephone | 903-723-1940
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Fax | 903-723-8307
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Provider Business Mailing Address
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Address Line | 300 WILLOW CREEK PKWY 210 A
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City | PALESTINE
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State | TX
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Zip | 75801-4421
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Country | US
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Telephone | 903-723-1940
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Fax | 903-723-9891
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. ASHA KANCHARLA
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Credential | MD
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Telephone | 903-723-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | L4014
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License Number State | TX
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