Provider Demographics
NPI:1689629123
Name:BOPPANA, SITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SITA
Middle Name:M
Last Name:BOPPANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 830066
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-0066
Mailing Address - Country:US
Mailing Address - Phone:972-644-1100
Mailing Address - Fax:972-644-1107
Practice Address - Street 1:2460 N CENTRAL EXPY
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2713
Practice Address - Country:US
Practice Address - Phone:972-644-1100
Practice Address - Fax:972-644-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8262B0Medicare ID - Type Unspecified
TXG57126Medicare UPIN