Provider Demographics
NPI:1003041815
Name:CHINTALA, SREEDHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEDHAR
Middle Name:
Last Name:CHINTALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9594 CAMPI DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:646-670-2580
Mailing Address - Fax:
Practice Address - Street 1:3360 BURNS RD
Practice Address - Street 2:GUN HILL ROAD
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-622-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24312207R00000X
VA0101267891207RC0200X
NY246774207RC0200X
FLME108555207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003122800Medicaid
FLME108555OtherFL LICENSE