Provider Demographics
NPI:1518929959
Name:TUMMALA, CHAITANYA VENKATA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:VENKATA
Last Name:TUMMALA
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 1:4461 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:214-983-0983
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:STE 409
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
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9525207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172136703Medicaid
TX8B7855Medicare ID - Type Unspecified
TXI05404Medicare UPIN