MEDICARE: DR. VIDYASAGAR CHODIMELLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	H22261	TX
2	207RC0000X	Cardiovascular Disease Physician	H22261	TX

General Provider Information

NPI Number	:	1215972419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDYASAGAR CHODIMELLA MD

Provider Business Mailing Address
First Line	:	4325 N JOSEY LN
Second Line	:	SUITE 204, PLAZA 3
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4635
Country	:	US
Telephone Number	:	972-395-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 N JOSEY LN
Second Line	:	SUITE 204, PLAZA 3
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4635
Country	:	US
Telephone Number	:	972-395-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/01/2010

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