Provider Demographics
NPI:1932294469
Name:DODLA, SARITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARITHA
Middle Name:
Last Name:DODLA
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 1:4400 HERITAGE TRACE PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8902
Mailing Address - Country:US
Mailing Address - Phone:817-518-9005
Mailing Address - Fax:817-518-9015
Practice Address - Street 1:4400 HERITAGE TRACE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8902
Practice Address - Country:US
Practice Address - Phone:817-518-9005
Practice Address - Fax:817-518-9015
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8643207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3382889-01Medicaid
NE47068731716Medicaid
TX3382889-01Medicaid
I65063Medicare UPIN