Provider Demographics
NPI:1750405015
Name:RAJANARENDER R. CHOLLETI, MD PA
Entity type:Organization
Organization Name:RAJANARENDER R. CHOLLETI, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-426-4700
Mailing Address - Street 1:1161 SW WILSHIRE BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5707
Mailing Address - Country:US
Mailing Address - Phone:817-426-4700
Mailing Address - Fax:817-426-4737
Practice Address - Street 1:1161 SW WILSHIRE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5707
Practice Address - Country:US
Practice Address - Phone:817-426-4700
Practice Address - Fax:817-426-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10030775OtherAMERIGROUP
TX90116910OtherPACIFICARE SECURE HORIZON
TX040329702Medicaid
TX7827163OtherAETNA
TX110224533OtherRAIL ROAD MEDICARE
TX0086GPOtherBCBS
TX90116910OtherPACIFICARE SECURE HORIZON
TX110224533OtherRAIL ROAD MEDICARE