1497918528 NPI number — SIRISHA CHUNDURI M.D.

Table of content: SIRISHA CHUNDURI M.D. (NPI 1497918528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497918528 NPI number — SIRISHA CHUNDURI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNDURI
Provider First Name:
SIRISHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497918528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1437
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36536-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-696-8033
Provider Business Mailing Address Fax Number:
214-361-2552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6901 SNIDER PLZ
Provider Second Line Business Practice Location Address:
STE#130
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75205-5648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-696-8033
Provider Business Practice Location Address Fax Number:
214-361-2552
Provider Enumeration Date:
07/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  35.098074 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: Q0895 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810021793 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000737151 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P01015059 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0055361 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".