Provider Demographics
NPI:1891796892
Name:SRINIVAS REDDY CHITTI MD PA
Entity type:Organization
Organization Name:SRINIVAS REDDY CHITTI MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:CHITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-633-9317
Mailing Address - Street 1:10501 VISTA DEL SOL DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7940
Mailing Address - Country:US
Mailing Address - Phone:915-633-9317
Mailing Address - Fax:915-633-8676
Practice Address - Street 1:10501 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7940
Practice Address - Country:US
Practice Address - Phone:915-633-9317
Practice Address - Fax:915-633-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0085207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00734WOtherMEDICARE
00734WOtherMEDICARE