Provider Demographics
NPI:1932958352
Name:THOTA, NAVEENA (MD)
Entity type:Individual
Prefix:
First Name:NAVEENA
Middle Name:
Last Name:THOTA
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 1:111 SPENCER LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8001
Mailing Address - Country:US
Mailing Address - Phone:774-262-7925
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY RM C10-12
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3542
Practice Address - Fax:718-334-3441
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program