Provider Demographics
NPI:1407894439
Name:CHITTOOR, SREENIVAS RAMDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SREENIVAS
Middle Name:RAMDAS
Last Name:CHITTOOR
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:4700 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1516
Practice Address - Country:US
Practice Address - Phone:972-686-6411
Practice Address - Fax:972-686-0594
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6907207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137725103Medicaid
TX137725105Medicaid
TX137725102Medicaid
TX137725107Medicaid
TX137725101Medicaid
TX8R1409OtherBLUE CROSS OF TEXAS
TX137725108Medicaid
TX137725111Medicaid
TX137725103Medicaid
TX990000553Medicare PIN
TX87W424Medicare PIN
TX137725107Medicaid
TX84W410Medicare PIN
TXD90104Medicare UPIN
TX8L13223Medicare PIN