Provider Demographics
NPI:1720106107
Name:SURENDRANATH, CHITTAMURU V (MD)
Entity Type:Individual
Prefix:DR
First Name:CHITTAMURU
Middle Name:V
Last Name:SURENDRANATH
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:PO BOX 680935
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-0935
Mailing Address - Country:US
Mailing Address - Phone:210-682-0140
Mailing Address - Fax:210-682-3238
Practice Address - Street 1:7061 BANDERA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1266
Practice Address - Country:US
Practice Address - Phone:210-682-0140
Practice Address - Fax:210-682-3238
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4257208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA3473OtherPTAN
TX00669GMedicare PIN