Provider Demographics
NPI:1790789436
Name:THOTA, ARCHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:THOTA
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 1:2300 W FM 544
Mailing Address - Street 2:ST 220
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098
Mailing Address - Country:US
Mailing Address - Phone:707-666-3490
Mailing Address - Fax:
Practice Address - Street 1:617 CLARA BARTON BLVD
Practice Address - Street 2:STE 102
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5761
Practice Address - Country:US
Practice Address - Phone:972-485-4440
Practice Address - Fax:972-485-4443
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH29559Medicare UPIN
TX8645B8Medicare ID - Type Unspecified