45D1081705 CLIA NUMBER - VIDYASAGAR CHODMELLA, MD,FACC,PA

Laboratory Demographics

CLIA Number: 45D1081705

Facility Name: VIDYASAGAR CHODMELLA, MD,FACC,PA

Facility Address:
4325 N JOSEY LANE, SUITE 204
CARROLLTON, TX
ZIP 75010
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Facility Phone Number: 972 395-7400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215972419

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	45D1081705
LAB Type	Physician Office
Facility Name	VIDYASAGAR CHODMELLA, MD,FACC,PA
Street	4325 N JOSEY LANE, SUITE 204
City	CARROLLTON
State	TX
ZIP	75010
Phone	972 395-7400
CertificateType	4
CertificateEffectiveDate	3/24/2024
CertificateExpirationDate	3/23/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024