Provider Demographics
NPI:1932260668
Name:RUMALLA, SMITA KASAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:KASAT
Last Name:RUMALLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4351 BOOTH CALLOWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7319
Mailing Address - Country:US
Mailing Address - Phone:817-284-1165
Mailing Address - Fax:817-284-4990
Practice Address - Street 1:816 KELLER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2479
Practice Address - Country:US
Practice Address - Phone:817-431-3800
Practice Address - Fax:817-431-5232
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T83UMedicare PIN
NJH12824Medicare UPIN