Provider Demographics
NPI:1962688580
Name:VYTLA, NAGA S (MD)
Entity type:Individual
Prefix:
First Name:NAGA
Middle Name:S
Last Name:VYTLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N COIT RD STE 2502
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6664
Mailing Address - Country:US
Mailing Address - Phone:972-295-9000
Mailing Address - Fax:
Practice Address - Street 1:1400 N COIT RD STE 2502
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6664
Practice Address - Country:US
Practice Address - Phone:972-295-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234284208M00000X
TXU0453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079189AMedicaid
RINV78494Medicaid
MA000533701Medicare PIN