Provider Demographics
NPI:1477798718
Name:DONTHU, SOUJANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOUJANYA
Middle Name:
Last Name:DONTHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 VIRGINIA PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5402
Mailing Address - Country:US
Mailing Address - Phone:972-369-0214
Mailing Address - Fax:972-369-0710
Practice Address - Street 1:5881 VIRGINIA PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5402
Practice Address - Country:US
Practice Address - Phone:972-369-0214
Practice Address - Fax:972-369-0710
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439947207R00000X
PAMT187960390200000X
TXN7536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335695YKP5Medicare PIN