Provider Demographics
NPI:1073056297
Name:CHAITANYA TUMMALA MD PA
Entity Type:Organization
Organization Name:CHAITANYA TUMMALA MD PA
Other - Org Name:INFECTIOUS DISEASE ASSOCIATES OF NORTH TEXAS, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:TUMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-396-8877
Mailing Address - Street 1:4461 COIT RD STE 409
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0526
Mailing Address - Country:US
Mailing Address - Phone:214-396-8877
Mailing Address - Fax:
Practice Address - Street 1:4461 COIT RD STE 409
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0526
Practice Address - Country:US
Practice Address - Phone:214-396-8877
Practice Address - Fax:214-983-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3968018Medicaid