Provider Demographics
NPI:1710369160
Name:THOTAKURA, DEEPTHI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTHI
Middle Name:
Last Name:THOTAKURA
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: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:972-997-9800
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1105 CENTRAL EXPY N STE 320
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6104
Practice Address - Country:US
Practice Address - Phone:469-467-4392
Practice Address - Fax:469-342-6750
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10054296207R00000X
TXR7616207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10054296OtherPIT